Family Transcultural Consultation: The Borders of Care

FAMILY ISSUES IN THE 21ST CENTURY

FAMILY TRANSCULTURAL CONSULTATION: THE BORDERS OF CARE

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FAMILY ISSUES IN THE 21ST CENTURY

FAMILY TRANSCULTURAL CONSULTATION: THE BORDERS OF CARE

ALFREDO ANCORA

Nova Science Publishers, Inc. New York

Copyright © 2010 by Nova Science Publishers, Inc. All rights reserved. No part of this book may be reproduced, stored in a retrieval system or transmitted in any form or by any means: electronic, electrostatic, magnetic, tape, mechanical photocopying, recording or otherwise without the written permission of the Publisher. For permission to use material from this book please contact us: Telephone 631-231-7269; Fax 631-231-8175 Web Site: http://www.novapublishers.com NOTICE TO THE READER The Publisher has taken reasonable care in the preparation of this book, but makes no expressed or implied warranty of any kind and assumes no responsibility for any errors or omissions. No liability is assumed for incidental or consequential damages in connection with or arising out of information contained in this book. The Publisher shall not be liable for any special, consequential, or exemplary damages resulting, in whole or in part, from the readers‟ use of, or reliance upon, this material. Independent verification should be sought for any data, advice or recommendations contained in this book. In addition, no responsibility is assumed by the publisher for any injury and/or damage to persons or property arising from any methods, products, instructions, ideas or otherwise contained in this publication. This publication is designed to provide accurate and authoritative information with regard to the subject matter covered herein. It is sold with the clear understanding that the Publisher is not engaged in rendering legal or any other professional services. If legal or any other expert assistance is required, the services of a competent person should be sought. FROM A DECLARATION OF PARTICIPANTS JOINTLY ADOPTED BY A COMMITTEE OF THE AMERICAN BAR ASSOCIATION AND A COMMITTEE OF PUBLISHERS. LIBRARY OF CONGRESS CATALOGING-IN-PUBLICATION DATA Ancora, Alfredo. [Consulenza transculturale della famiglia. English] Family transcultural consultation : the borders of care / Alfredo Ancora. p. ; cm. Includes bibliographical references and index. ISBN 978-1-61209-075-7 (eBook)

Published by Nova Science Publishers, Inc. New York

CONTENTS Preface

vii

Introduction

Julian Leff

ix

Chapter 1

A Few Premises

1

Chapter 2

The Culture of Meeting

25

Chapter 3

Cultural Processes and Migratory Processes

49

Chapter 4

The Services Provided by Mental Health Centres as Cultural Extensions into the Territory

77

Transcultural Consultation and Foreign Families – Between Saying and Doing: “Contaminated Therapies”

91

Chapter 5 Conclusions

119

Appendix: Welcome Form

125

References

131

Index

151

PREFACE This new and unique book reviews research on the topic of mindsets among families in various cultures and the role of the “border worker”. Migration processes, family reunifications, mixed couples, pathologies of transition, syndromes caused by uprooting are daily issues in our outpatient clinics, hospitals and services. The psychologist, the psychotherapist, the social worker, and the nurse each takes on a new role of “border worker”, which is specified by pre-defined methodological and professional grids and yet is also shaped by the multiple realities and different levels that it requires to be in contact with. There is an urgent need for renewed ways of thinking and intervening which are more flexible, open and “nomadic”.

INTRODUCTION Alfredo Ancora has established himself as an experienced transcultural psychiatrist, who applies his expertise to clinical encounters with families, many of whom are migrants to Italy. Ancora presents the first half of this book as a journey. He himself has made an unusual journey to Siberia to meet and talk with shamans and other traditional healers. Their practice is invariably to see the client with their family, in contrast to the western biomedical convention of focusing on the individual. Ancora has adopted this approach in his own clinical work, which is illustrated with several detailed case stories in the second half of the book. Ancora applies anthropological concepts to the therapeutic encounter, and argues that the therapist should become a builder of dialogic realities in an equivalent way to the traditional healer. He defines the term „transcultural‟ as the crossing of limits and frontiers, and the theme of boundaries pervades the entire book. As evidence of the transcending of boundaries, Ancora brings to bear on his subject an admirably wide variety of sources from the literature: in addition to the expected anthropologists, philosophers, travellers, novelists, historians and classical authors enrich his text. Given his busy clinical life, one wonders when he has time to read so extensively. One of the central themes of the first half of the book is the nature of the other and our relationship with him/her. This is obviously salient when dealing with people from cultures remote from our own, in his practice not only Yugoslavs, Eritreans and Congolese, but migrants from Sardinia. He writes about the difficulty of abandoning our deeply held prejudices and stereotypes which stand in the way of connecting with the human being with whom we are confronted. This is particularly problematic when trying to form a relationship with a person with schizophrenia. He uses a metaphor for this endeavour: entering the world of the psychotic is a journey into the interior with few maps. How much more daunting is this when the person with a psychotic illness is also from a different cultural group – what one could call double jeopardy. In taking us along as travellers, Ancora deals with weighty themes, for instance the relationship of man to nature, with such lightness of touch (aided by an excellent English translator) that it often feels less of a journey than a dance. The clinical material that forms the second half of the book is very instructive. The theme that pervades the accounts of these seven dislocated families attending Ancora‟s service is that each family is constrained by a desperate need to maintain solidarity in the face of a majority culture perceived as alien or even hostile. One of the penalties of this rigidity is the impossibility of showing weakness and sharing emotional responses. Ancora‟s aim is to loosen up the tight formation of each family in order to promote personal differentiation and to allow the expression of individuals‟

Julian Leff

x

feelings. To achieve this he takes a systemic approach (Bateson is one of his gurus), but leavens it with eclectic strategies which are often creative. In this era of unprecedented human migrations, provoked by push and pull factors, there can be few psychiatrists on earth who would not benefit from close study of Ancora‟s formulations, both theoretical and clinical. Julian Leff

Chapter 1

A FEW PREMISES This book is made of interstices and boundaries, crossings and contaminations, and, finally, thoughts recited in a high voice in a street theatre, where actors and walk-ons come onto the stage and then leave, often leaving behind their masks, and thus providing us with a new piece of knowledge. This form of “oral publication”, as Pierre Bourdieu1 would have it, allows approaching an idea by means of consecutive approximations and suggesting different points of view on a particular topic, thus getting a more complex and varied understanding. I wish to avoid any self-satisfied soliloquy – that would hinder all transformative thought – and try and grasp the social essence that lies at the heart of the individual (Bourdieu), also by taking on a “political” commitment, in the sense meant by Gramsci2 (according to whom science was an eminently political activity), in whose view knowledge and the politics of science must be kept separate from power.3 Accordingly, transculture turns into a passage across other worlds and other ways of knowing, giving us the opportunity to change our horizons in research, care, and, in general, our attitude to life. This “mental mobility” is the challenge of any transcultural discussion. Through the whole of his work Bateson provides us with bridges “between the facts of life and behaviour and what we know today about the nature of pattern and order” (Bateson 2000, p. xxxii) to create new products that are still handcrafted. Today, the risk of an excessive use of techniques, to the detriment of the thought underlying them, can overshadow the whole process of reflection and interrogation required by our particular clinical activity. Besides, it is to be noted that most family therapists practise in the public services: veritable laboratories where different methodological approaches, people, emotions and intervention patterns continuously combine with one another, in a way that is often far from what they learn in their training. Obviously, along the path that I wish to trace out I shall not endeavour to do without my background, that is systems science. 1

Bourdieu, P. and Wacquant, L. J. D. (1992). An Invitation to Reflexive Sociology. Cambridge: Polity Press. Gramsci, A. (1975). Letteratura e vita nazionale. Rome: Editori Riuniti. 3 Gramsci, A. (1996). Prison Notebooks. Vol. 2. Ed. and trans. J. A. Buttigieg. New York: Columbia University Press. (Originally published as: (1975). Quaderni del carcere. Vol. II. Turin: Einaudi.) “Is not science itself „political activity‟ and political thought, in as much as it transforms men, and makes them different from what they were before?… And does the concept of science as „creation‟ not then mean that it too is „politics‟? Everything depends on seeing whether the creation involved is „arbitrary‟, or whether it is „rational‟ - i.e. useful to men in that it enlarges their concept of life…” 2

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The problem is broadening theoretical assumptions – with the aim to highlight the gap between certain lifeless paradigms and the variedness of real life experience – and attempting to avoid the usual dichotomous associations (mind/body, the West/the East, thought/action, and so on) which affect so deeply our habit of mind. To what extent are we still sensitive to such concepts as ethnocentrism, racism, and ethnic prejudice? What is our attitude before “that something that moves forward”, a stranger who suddenly bursts in our thoughts, not only in relation to assistance issues? Is it all about a cultural encounter/clash with our respective views on the world, the family, life as a couple, and values? Our complex society, which is about to become a real multicultural and multiethnic one (and yet this slow process is not to be taken for granted), is a veritable challenge both for the worker‟s performance and the framework of his activity. That is why, at the beginning, I have made reference to interventions that, in their doing, acquire contaminating and contaminated elements and result in something not yet defined, something mestizoed, and with new possibilities of combination.

1.1. TRANSCULTURAL PSYCHIATRY In the framework of the current scientific debate, this discipline is placed among the socalled boundary- or border-sciences and is old and modern at once. It is old because it is influenced by factors such as culture, symbols, religious beliefs, and world views which are inextricably linked to the way the symbol manifests itself; it is modern, and recent, because it is a tool for linking and integrating all the disciplines which represent the varied worlds of the psyche. Transcultural psychiatry has often been given a narrow interpretation by being confined to the scope defined by the pair “psychopathology/culture” or the investigation of so-called “exotic” syndromes (Arieti 1959). In order to broaden this interpretation, it may be useful to consider the openness implied by the prefix trans, i.e. the change of direction in the observation of certain scientific and cultural phenomena, as if we passed through – rather than above – ways of thinking, their expressions or manifestations, trends, and schools of thought (Ancora 1997a). Geometrically, this change of direction is to be imagined as simultaneously transversal and circular, just like an ideal thread that, pulled across different cultures and branches of knowledge, links them together. This direction would enable knowing/understanding what “else” happens in other worlds and in other ways, in the universe of illness, care, and health, without falling into the trap of merely making comparisons or associating culture to symptoms. This implies being ready to observe and question oneself rather than create enclosures and investigation niches. Actually, psychiatry is imbued with rites, mythology, and imageries impossible to be read by means of interpretive grids that are often too narrow: these elements play such an important role in the encounter with the patient that he acquires a sort of magical aura. What happens during a session remains a prerogative of the individual who creates, breathes in, suffers in and lives through it. What takes place is a particular transition, a passage across stories or narrative plots (or indeed a circularity of narrative thinking, as Bruner, 1991, would have it) which are described and disclosed through the special relationship connecting two or more people from different worlds, also culturally. On this

A Few Premises

3

point, Burton-Bradley (1975), the first psychiatrist to set up psychiatric services in Papua New Guinea, a real laboratory for anthropological research and studies (a description of the work carried out by Bateson, Mead and Fortune among the Iatmul people, in Papua New Guinea, shall be subsequently given), remarked that, in any physician-patient relationship, the two individuals involved, when not belonging to different cultures, at least, very often, belong to different, even diverging, subcultures. In this sense, the whole of therapy can be considered to be transcultural. Drawing on her “global and multiethnic” experience, Terranova Cecchini (1991) underlines that, as a method of diagnostic and therapeutic analysis, transcultural psychiatry can be applied to any context: from a highly industrialized environment to a remote village in a forest. Most importantly, it can also be a transformation journey, provided this uninterrupted transition across internal and external worlds leaves at least a slight trace inside us. Otherwise, it is just the umpteenth experience to go quickly through in order to burn up the following one, often without pausing to ask ourselves what this actually is or means. In other words, the risk is for us to become a container of ideas, experiences, work activities, where everything is considered temporary and protected by our internal barriers that do not allow any exchange, contact or change. Yet, the journey “across” might be the opportunity to start a journey “beyond”, a meta-journey, during which we could get lost, only to find ourselves again in other ways, able to aggregate ideas or “minds” (in the sense meant by Bateson). According to Galimberti (1992), “travelling is not reaching a destination, but exposing oneself to unusualness”, which means being willing to stake a part of oneself. Accordingly, the subject of transcultural studies is a transcultural mode, an attitude, a versus, a direction, a thought, something new and different to build, rather than an already made construction to face or destroy, or even to incorporate at the last moment, for fear of exclusion from the most “fashionable” debates. If I were to cite an example from my clinical practice, it is as if one expected to come to know the varied and complex world of a psychiatric patient in a one-hour therapeutic session, without even doubting that this were not in the least adequate: “The world has not shown up for its first session!”4 That is why, it would be very useful to observe a patient further, possibly outside the clinical/hospital context, in his world, during his daily life, at home, among his relatives and friends, in the places he goes to (church, political party, clubs, etc.), and in his hard times. When a fragment of life associated to cultural or pathological elements “gets” into the session, it very often appears as if it were unconnected from all the rest. In short, the term “transcultural” applies to something that goes beyond dealing with a psychiatric problem, within a particular culture, on the part of someone from a different culture. In the face of new methodological approaches and the emergence of unknown potentials, we risk holding onto the restraints stemming from our usual way of observing/working. In order to start on a new route, we should attempt, for an instant, to “suspend” our mental categories, so as to catch a glimpse of some other shades, and “get across” our own and the others‟ “prejudices” (Cecchin 1997).

4

Samuels, A. (1993). The Political Psyche. London; New York: Routledge, p. 29.

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This partly happens when we are confronted with a challenge, such as a hospitalised migrant in a state of crisis, a “colleague” from a different country who treats a patient with a totally different method than us or someone whose soul is possessed by the “devil”. Taking off the glasses through which we normally look at the world around us might not always be advisable: in some cases, we would risk a real catastrophe! When we cross these true “minefields”, we have to advance carefully and gradually, in the full awareness of our limitations, with no sprints ahead, respecting the culture from which we come from. Even the guise of the westerner, withdrawn into himself and always guilty, is now inadequate to approach certain critical expressions of today‟s world, namely the more or less concealed need for spirituality, the sudden emergence of “other” cultures, and the miraculous conversions to new religions. It would perhaps be more useful to start in a softer way, with no jerks and longer pauses for reflection. It is in this framework that transcultural psychiatry is to be placed, as a science based on boundaries between countries and people that finds its raison d‟être in its own transcontextuality. As a consequence, psychiatrists find themselves personally involved: they are the ones at stake, with all their more or less static categories, and their own (un)willingness to challenge themselves, regardless of transferential and countertransferential elements. Only in this condition can they realize the real intensity of the desire to change that their own words convey, words which are often uttered in a sort of acoustic continuum, as an end in itself, that changes nothing, even when the words spoken are words of change (Sloterdijk 1987). This particular viaticum may represent an ideal path for any wanderer/“passeur” (Nathan 2001) /pilgrim/researcher5 eager for knowledge and new routes. Actually, the task is more difficult for those who have to deal with the trammels of bureaucracy in the public psychiatric service where the encounter/clash between a culture they believe they know and one they certainly do not know is minimized, in the name of the quantification of interventions. Moreover, research/intervention (given the aforesaid methodological observations, these two concepts are to be considered interconnected) in this discipline cannot be the mere transposition of “other” phenomena, geographically far away and, therefore, perceived as interesting and picturesque. “Are we sure that we know our own culture? Or, rather, isn‟t it true that it defines the conditions through which we experience ourselves and our world, its being thinkable and knowable, without being really known?” (Berlincioni, Petrella, and Cartelli 1996, p. 244). Going back to ourselves is the real goal of this discipline, even though the study of culture-bound syndromes has often only served the needs related to diagnostic nomenclatures, to the detriment of horizon-broadening activities, that should strictly pertain to this subject. For that matter, for example, also cultural trends have contributed to ignite a sort of passion for the East, perceived as beautiful because it is far away and, especially, different. Evidence of this is Why Did Bodhi-Dharma Leave for the East?, a very interesting movie that does not convey the usual message on Zen Buddhism, which we hold dear due to its soothing and strengthening camomile tea-like effects. 5

Or, more simply, a “truth seeker”, as G. I. Gurdjieff would define himself, an extraordinary Eastern herald and physician who organized expeditions to the heart of Asia in search of hidden knowledge. See: Gurdjieff, G. I. (1963). Meetings with Remarkable Men. New York: E. P. Dutton and Co.

A Few Premises

5

In this movie there is no hint at the convenient, predictable and, by now, sickly dichotomous view of the East versus the West6 and intuition versus rationality. Rather, Korean film director Yong-Kyu Bae asks some disturbing questions addressing not only himself, but also those who, like me, consider answers to be more important than questions. In the movie there emerges no desire to show that the East is superior to the West, or vice versa, and emphasis is given to the dark and unknown aspects of the West, with its sense of becoming and motion: finding the truth at all costs is not interesting, as isn‟t the truth viewed as a permanent fight. The current epistemological debate can help: any phenomenon changes merely because it is observed. But this modern and yet old concept (Giambattista Vico‟s verum ipsus factum echoes in our memory!) is always difficult to apply to any science in general, and to the psychiatric one in particular. One need only think of how often we have kept a patient's life at a distance, considering him only from the point of view of his disease, and taking on an almost defensive attitude on the pretext of having to restrain our personal involvement. On delirium and hallucinations Leff has a point when he asserts that they cannot be separated from the contents of an individual‟s convictions; that they depend, for the individual, whether mentally ill or not, on his life experiences; hence the unavoidable influence exerted by his culture (Leff 1988). At the beginning I underlined the peculiar “atmosphere” of a session, an encounter between someone asking for help and someone who is willing to help. It is useful to note the particular nature of this relationship, where very intense moments can be experienced – with a true suspension of usual parameters, such as time and space –, when “colleagues” from other cultures try out new paths of knowledge and new languages. In Structural Anthropology (Lévi-Strauss 1968, p. 198) Lévi-Strauss states that “the shaman provides the sick woman with a language, by means of which unexpressed, and otherwise inexpressible, psychic states can be immediately expressed”. Obviously, the aforementioned concepts do not aim to support the absolute need for the inclusion of anthropology into the worker‟s therapeutic bag – the lack of which might be regarded as an obstacle to the building of meaningful relationships – but, rather, stress the importance of the attitude of mind over the ability to master a technique. On this point, master Devereux (1970) – whose works, for too long a time, have not been given the due attention in Italy – argues that expecting from a psychiatrist to become an expert in ethnography (not to be confused with ethnology) is unfair and unreasonable as is expecting him to study in detail the culture of each patient that he has to diagnose and treat. Actually, one of the goals of this particular interpersonal encounter is understanding, or rather, “trying to understand” man as organically as possible. Indeed, attempting to separate the investigation of culture from that of the psyche would be an abstract and constrictive operation, since the two aspects complement each other. The therapeutic encounter is a true 6

Among the many publications on this theme I recommend: Irigaray, L. (1993). Je, tu, nous: Toward a Culture of Difference. Trans. A. Martin. London; New York: Routledge; Mormina, G. (ed.) (1994). La malattia mentale a confronto: Oriente e Occidente. Pistoia: Centro di Documentazione di Pistoia Editrice, a collection of the speeches held during a conference in Scicli (near Ragusa, in Sicily) on the typical categories of the two systems of thought, from the relationship between man and nature to microcosm versus macrocosm, normality versus deviance, and so on; Clarke, J. J. (1994). Jung and Eastern Thought: A Dialogue with the Orient. London; New York: Routledge. In his work Clarke emphasizes how Jung attempted to build bridges of understanding between the East and the West: “What is the Orient? The East? It is not a fact of nature, it is an idea – precisely a Western idea – which has a history and a pathology, and is infused with myth and hidden meaning” (p. 14).

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cultural encounter7, rather than a mere confrontation between the representations of two different worlds. Culture becomes the “physical materialization of the encounter with the other” (Ancora 1999) through levels – at times metaphorical, at times real – that continuously refer to one another. At first, the physical and mental space where the encounter happens seems fragmented, or rather not clear-cut, in such a manner that all modes of meeting are made possible (Kern 2003). The kind of encounter so far described implies, inter alia, a true risk: that of losing oneself. However, it also implies the opportunity to recompose oneself on a different organizational level. On this point, representatives of other cultures (traditional healers, shamans, and so forth) show us that only through the creation of a different space – seemingly suspended and elusive – can we proceed towards the next phase of a therapeutic process, where we can create a unique and unrepeatable experience. In this virtual and yet real space, new modes of knowledge and new ways of aggregating ideas can be tested. It is possibly for this reason that today, more than ever, the need is felt to turn to the so-called anthropological line of thought, which means – not only etymologically speaking – of man, or human. This dimension continually stimulates our memory because, even though with some fears, it takes us back to “how we were” – to the view of ourselves as primitive pre-logical beings, or rather beings with a different logic – and allows us to understand how man has, in a way, become a-logical. Consequently, transcultural psychiatry takes on the role of a scientific metaphor, a trace (not a branch) of an eclectic knowledge that points to a very distant direction, that of the search for man‟s origins and identity. The study of “other” phenomena has not always succeeded in emphasizing the drifts described so far: manuals often focus on objective data according to a line of thought aimed at establishing comparisons, sometimes as an end to themselves, and failing to grasp deeper considerations or the “transformation” lived through by the worker, as well as its impact on his clinical practice and attitude. Besides being amazed at the discovery of new syndromes, we should start asking ourselves why the attempts to grasp evidence of cultural “intrusions” into psychopathological events are in such a small number, notwithstanding a very extensive literature. What is then the meaning of “culture”, a word that I have used so often thus far? Any narrow definition would be inappropriate. It is certainly a complex term whose meaning is very far from that of the 19th century, when culture was referred to as the product of education, a synonym of civilization (E. B. Tylor8 1920), as distinct from all that was natural and inborn. Of the many attempts to analyse this concept, the one made by Kroeber and Kluckhohn (1963) is the most remarkable one. They listed over three hundred definitions of culture, each corresponding to a particular author‟s path and a particular investigation method. In Il concetto di cultura (1970), Paolo Rossi, the book‟s editor, illustrates some of the most relevant anthropologists' thoughts. Others, including Leach (1961), maintain that culture is a badly defined and misleading category that only creates confusion and is useless to anthropologists as well as anyone who benefits from their work. Lévi-Strauss (1961) believes 7

Resnik advocates that the psychoanalyst‟s attitude towards the psychotic be similar to that of an ethnologist on the ground, at once witness of and participating in the culture he is observing; he is a part of the ground and changes it, though always maintaining his role as observer. (Lo spazio mentale nella psicosi, seminar at the Centro studi di psicoterapia e ricerca sistemica, Rome, 6 June 1986, personal paper.) 8 Tylor, E. B. (1920). Primitive Culture: Researches into the Development of Mythology, Philosophy, Religion, Language, Art and Custom. London: John Murray.

A Few Premises

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that culture is a manifestation of the world of the mind‟s abstract ideas and is, therefore, a communication means, a language. What matters to the French anthropologist is emphasizing its unconscious meaning, the deep structures that underlie the phenomena visible on the surface, rather than its social organization which, instead, is the subject of Malinowski‟s investigation (1968). Bateson (Bateson and Bateson 1988) maintains that “one meaning of that overworked word is the local epistemology, the aggregate of presuppositions that underlie all communication and interaction between persons, even in dyads, groups with only two members.” This short analysis of mine confirms how varied and multifaceted the concept of culture is, which is reflected in Gadamer‟s claim (1999) that culture is something that sustains us, but no one is wise enough to be able to say what it actually is. I would rather refer to culture as a cultural system, so as to emphasize its dynamic and communication aspects and the interactions among living and non-living beings. In my daily practice I come across two fundamental elements of culture: mobility and variety. Culture is not something that the individual or the group owns as such or as a legacy. It is rather a continuum of adaptability, a sharing of experiences, events and emotions. Schwab (1977) suggests that the symptom-frame relationship should be investigated more closely, when he underlines that man is a bio-social organism, not only modelled through his interactions with others and influenced by the customs and objects of his material culture, but also owning a cultural heritage; any consideration of a mentally ill person that does not place him in a cultural perspective is doomed to short-sightedness (cited by Llandrich 1988, p. 11). It is to be noted that, apart from its unquestionable progress in the realm of psychopharmacology, psychiatric thought has also advanced, though slowly, in the cultural field. This is proved by the fact that the DSM-IV, the most used diagnostic manual, takes into account new needs – even though they are pertinent to the relative and classifying logic on which it is based. On this point, in an article published in “Transcultural Psychiatry” (1998)9, Kirmayer described all the issues that were not only relational, but also related to the different “lines of thought” between the Culture and Diagnosis Work Group, made of experts in cultural psychiatry, and the task force of epidemiologists and specialists in nosography, in charge of the revision of the DSM-IV. The problems that were reported mainly concerned the diagnostic tools to be used. Upon release, the previous version of the manual, the DSM-III-R, was criticized because, concerning the problems related to culture-bound syndromes, it did not take into account any aspect of the delicate and complex symptom-context relationship, following an old, hard-dying ethnocentrically oriented view. Moreover, it was to be considered that the world did not only consist in the West and that, as a survey tool, the DSM was a technical manifestation of the culture and the approach of a single area of the planet to phenomena concerning most of the world population. Following in Arieti and Meth‟s10 wake (they coined the phrase “rare and unclassifiable syndromes” to refer to symptoms from other cultures), even the DSM-III-R used the notion of “atypicalness”, thus denying the spreading and the rooting of such symptoms in different 9

Kirmayer, L. J. (1998). The Fate of Culture in DSM-IV. In Transcultural Psychiatry, Vol. 35, No. 3, September. Arieti, S. and Meth, J. M. (1959). Rare, Unclassifiable, Collective and Exotic Psychotic Syndromes. In Arieti, S. (ed.), American Handbook of Psychiatry. Vol. I. New York: Basic Books.

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cultural contexts. Recently, following criticism of the criteria used – too North Americanoriented –, both the DSM-III (latest version) and the DSM-IV have showed to reflect more closely the varied reality of a multiethnic and multicultural society, by adding an Appendix.11 Today, in the United States, the stakes are high: “ethnic minorities” are reckoned to play an increasingly important role. Hence, the claim for a version of the DSM-IV closer to social changes has been acknowledged more widely than in previous editions. Taking into account culture is not a simple task and yet it is necessary. From this perspective, diagnosis would represent not only a cultural issue, but also a social one, i.e. it can have a specific value only if it is approved by the community. The authors of an interesting publication on this issue12 took the hint from the criticism levelled to the DSM-III-R and its generic character and allinclusiveness, that is, its having risked to represent “all for everyone” and, thus, its being unable to provide deep analyses. However, it is to be kept in mind that it is not advisable to create expectations based on diagnostic categories or regard as concrete classification schemes that are just “acts of imagination” and, as such, provide questionable outcomes. The goal set by these criteria – associating a particular sign to a specific meaning – can lead to the risk of turning signs into absolute values, indeed true identities, thus inducing all clinicians who believe in the absolute soundness of these schemes to think that their prophecies have been fulfilled. The need for criteria able to “culturally” define the structure and the contents of the Diagnostic and Statistical Manual of Mental Disorders was not fully addressed in either the DSM-III or the DSM-III-R (save a slight mention in the introduction). This reflects a gap which for long has kept nosology and diagnostics experts apart from those who deal with the issues related to the suffering world.13 The goal, albeit limited, that the Culture and Diagnosis Work Group finally achieved was the definition of firm criteria that would serve as the base for all kind of assessment: a) the individual‟s religious, linguistic and ethnocultural identity; b) the description of the disorder and treatment within a cultural framework and a psychosocial environment; c) the relationship between the individual, the subject and the clinician (considering the clinician‟s culture, also in relation to his family of origin and his professional career). Obviously, not all of the submitted criteria were accepted. The part that wasn‟t was included in a “Source Book”,14 an appendix that was more varied and detailed than the previous. As a matter of fact, an unbalanced conflict arose and the issue of the quantification and the recording of pathological entities clashed against the convictions of those who attempted to understand psychic suffering by taking into account also a specific context and culture. However, it is to be acknowledged that this manual was a real leap forward; on the one hand it was the result of the pressure exerted by groups that, meanwhile, have become “former cultural minorities”, on the other it witnesses that openness that is slowly taking shape in the narrow and rigorous realm of data surveying. This is a reminder of the fact that the DSM-IV is – and must be considered as – an incomplete tool, and, accordingly, each subsequent edition shows an increasing need for updating and integration. 11

Notably an “Outline for Cultural Formulation” and a “Glossary of Culture-Bound Syndromes”, both included in the DSM-IV, published in 1994 by the American Psychiatric Association. 12 Mezzich, J. E., Kleinman, A., Fabrega, H., and Parron, D. L. (eds.) (1996). Culture and Psychiatric Diagnosis: A DSM-IV Perspective. Washington, DC: American Psychiatric Press. 13 On these issues see: Zapparoli, G. C. (1991). La diagnosi come momento di integrazione e di differenziazione. In La psicosi e il segreto. Turin: Bollati Boringhieri. 14 Mezzich, J. E., Kleinman, A., Fabrega, H., and Parron, D. L., op. cit.

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Any tool always represents a specific way of looking at reality and entails the risk to objectify psychic disorders, by rendering them similar to any other clinical diseases. I certainly do not agree with the approach that underpins this kind of intervention because other tools, such as dialogue, the subjectification of the encounter, and the creation of a therapeutic reality seem today irreplaceable. The problem is placing them into a flexible context, such as the therapeutic relationship. In a publication on Bateson, Stefano Brunello15 illustrates an idea which is related to the issues discussed in this chapter: “In Whitehead‟s16 wake, Bateson insists that the categories described are to be considered only as the observer‟s practical tools whose task is labelling and classifying the observed material with the aim of their systematization within the explanation.” To believe that these labels are real “things” means to fall prey to what Whitehead describes as “the fallacy of misplaced concreteness”. According to him our categories (religious, economic, and so on) are not real divides in the cultures that we observe but, rather, mere abstractions that we create for our convenience when we describe cultures using words. Both culture and diagnostics are parts of a more varied and complex encounter that could never be brought down to a series of “evaluation items” or “anthropologically correct” theories. Once diagnostics has been completed (in the etymological sense of “knowing through”), the problem is understanding what attitude is to be taken and, consequently, what intervention is to be chosen. Creating clear-cut frames where diagnosis and intervention are distinguished is not always simple, especially in the context of an activity wavering between increasingly technical drifts and more and more complex realities. In this regard, the Appendix contains a form titled “Welcome Form”, where every term is a “thought-word”. It is important to keep in mind that this form is a mere survey tool, supporting an encounter that is yet to be built.

1.2. “MESTIZO” GREGORY BATESON: IS THE ORIGIN OF FAMILY THERAPY TO BE FOUND IN PAPUA NEW GUINEA?17 Of all psychotherapies, it is to be acknowledged that systemic psychotherapy is one of the few to draw on anthropology, ethology, ethnography, etc., as well as from cybernetics and systems theory. Undoubtedly the main integrating role has been played by Gregory Bateson who started his long transdisciplinary and transcontextual path from anthropology to “cross”, later on, many other sciences. Over the last few years, the scientific debate has apparently overlooked these aspects, to the benefit of technicalities or a far too constrained use of paradigms. I will attempt to broaden the horizon to re-define and re-build “passages across” and connections in relation to a complex animal such as man. Actually, what is man? Bateson raises this question in an article issued in 1959. “Man is encounter. He is „part of‟ and 15

Brunello, S. (1992). Gregory Bateson. Verso una scienza eco-genetica dei sistemi viventi. Padua: Edizioni GBS, p. 58. 16 Alfred North Whitehead was a logician, a mathematician and a philosopher who wrote, among other things, Science and the Modern World (Cambridge: Cambridge University Press, 1926). 17 This is a question which I asked Paul Watzlawick during a conversation I had with him in 1987 (at the time I was dealing, under his direction, with the Italian edition of his book The Invented Reality). The eminent representative of the Mental Research Institute of Palo Alto didn‟t give a direct answer to what was a purposely provocative question and, instead, replied: “It was Bateson‟s idea…” See also: Ancora, A. (1990). Conversazione con P. Watzlawick. In Il Bollettino. No. 21, June 1990. Milan: Centro milanese di terapia della famiglia.

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questions on a science that cannot stop hoping for a „we‟ ” (cited by Marzari 1998, p. 28). Guidano (1988) could “ideally” answer that he is an epistemological animal. Bateson‟s story, the story of a distinguished anthropologist, as The Times described him after his death (7 July 1980), deserves a second reading, considering what he wrote on the meaning of “thinking by stories”, as an additional opportunity for knowledge. The elitist atmosphere of Cambridge, where his father – a renowned biologist and zoologist and a great admirer of Gregor Mendel (hence, his son‟s first name) – was a fellow of prestigious St. John‟s College, greatly influenced the “fate” of the young zoology student who started his academic career in his father‟s footsteps. As described in an excellent biography by David Lipset (1982), he lived in Merton House, a sort of house-laboratory where he set up an incubator and a fowl house to investigate animal behaviour on the field, grouses included. This life experience was a constant incitement for him to “learn how to learn”. Later on, the curious student realized that he needed broadening his horizons. In particular, after coming back from his first trip to the Galapagos islands, made famous by the research performed by Darwin (whom both the son and the father deeply admired), he realized that, in reality, he had given more attention to people than animals. Meeting Malinowski was fundamental to him and marked his final scientific break with his father. His first teacher was Alfred Haddon, a Cambridge anthropologist, who started the well-known “field expeditions” to Torres Strait, separating the southern coast of New Guinea from Cape York, in northern Australia. The research aimed, in particular, to check and verify the data, studies and sources gathered in that area by the explorers, missionaries and travellers who had ventured that far up to then. Later on, Bateson recalled his great interest in these innovative on-the-field methods, which were based on data collection, the use of specific instruments to measure the skulls of the individuals under investigation, and, especially, the difficult art of interviewing. Moreover, he deepened his acquaintance with Radcliffe-Brown who was with Malinowski among the main representatives of the so-called functionalist school, whose aim was attempting to explain the social structure, behaviours, and relationships being established according to the function they develop within a specific sociocultural system. Due to his powerful and genius-like nature, Malinowski aroused strong passions and taught his students “to think” and “observe by participating”, two breakthrough methodological elements which were to become central to Bateson‟s thought. However, Bateson was disturbed by Malinowski's “on-the-field” research methods because he considered them rough, especially since they often consisted in grabbing natives by the lapels to prevent them from running away (Lipset 1982), and by the fact that these were taught as real research techniques. Radcliffe-Brown (1973) was more refined and closer, also pedagogically, to his students‟ needs. He viewed social anthropology as “the theoretical natural science of human society, that is, the investigation of social phenomena by methods essentially similar to those used in the physical and biological sciences”. These issues were at the heart of the analogic transposition “from one science to the other” that would later imbue the structure of Bateson‟s scientific metaphors. Moreover, the observation of the animal organism revealed that interstitial cells and fluids were structured in a network of mutual relationships which was similar, in Radcliffe-Brown‟s view, to the pattern that society gave itself by creating groups and subgroups. In the wake of this line of thought, Bateson very gladly accepted a scholarship for an expedition to New Guinea, specifically to the higher Sepik district, which supposedly was inhabited by a primitive, though culturally very advanced, people: the Iatmul. Bateson

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travelled in third class and made acquaintances among fellow travellers and the crew alike. His familiarity with them was such that, when he joined a fancy dress party, he decided to wear the disguise of a naturalist researcher and simply put on a sign reading “Myself”, as reported by Lipset. Once in Australia, he was advised against going to New Guinea, on account of his lack of experience. Therefore, he visited the Baining, in New Britain, where he could confirm that his investigation methods were not in the least adequate. This “failure” greatly matured him and played a significant role in his decision to reach Papua for which, earlier on, he had not felt ready. Once there, he met Reo Fortune and Margaret Mead (he would marry her later on). This peculiar trio was united not only by common scientific stimuli and interests, but also by a combination of passions, dislikes and strong competition. Mead came from the American anthropological school of which Franz Boas was the main representative. Fortune18 had worked on Dobu island, west of Papua, where he had studied the connection between the amok syndrome and sorcery. The results of his work were later reported by Burton-Bradley (1975, 1987), an Australian psychiatrist who moved to Papua in the Fifties (at the time the country was an Australian protectorate and became the independent republic of Papua New Guinea in 1975) to set up psychiatric services, in those very territories that, only a short time before, had served as an extraordinary laboratory for observation and investigation. BurtonBradley made one of the first attempts to systematize clinical manifestations within their own cultural processes. Among these the “cargo cult” (1973) is certainly worth of mentioning. It is an anxiety syndrome manifesting itself, inter alia, as a condition where the individual waits for a supernatural force sent from the sky (a cargo plane, precisely) by his ancestors and bringing all sorts of objects of wealth. Among other syndromes described by Burton-Bradley that would have appeared “strange and bizarre” (as Bateson would have it) if considered outside their cultural context, the “forgery” and the “coprolalia” ones are also worth of mention. The former mostly affects migrants who, after settling in a town and finding a job in a bank, surrender to the lure of paper pieces (cheques), that have the magical power to turn themselves into whatever one desires and that, therefore, they think they can use as they wish. The coprolalia syndrome (another disorder pertaining to the acculturation issue, with all the consequent cultural shocks suffered by those who leave plateaus for towns) is likewise characterized by “abnormal reactions” aroused by objects. In this case, they are triggered by fetishes, such as the telephone, which can convey omnipotence to anyone who comes into contact with them for the first time. Reverting to the aforesaid trio, Margaret Mead had performed research in Samoa (1928) and New Guinea (1930) with the aim of proving that personality patterns were culturally and not biologically determined. Her future husband‟s interest had also been aroused by these considerations when reading Patterns of Culture by Ruth Benedict (1959).19

18

Apart from the theme of “relational” dynamics, Fortune had already published a work related to his stay on this island, a work which still today is unique in its kind: The Sorcerers of Dobu (London: Routledge and Paul Kegan, 1932). The amok syndrome is characterized by a “homicidal and suicidal fury” which affects especially men. Holding a kiss (a very pointed dagger), people suffering from amok engage in a wild run that ends with the death of anyone they may come across or themselves. Apparently, this syndrome is still widespread in Malaysia and the Philippines (cf: Leff 2008). 19 Benedict, R. (1959; first printed: 1934). Patterns of Culture. New York: Houghton Mifflin.

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Before dwelling on Gregory Bateson‟s first anthropological work, it is important to describe the stance he took, since the very beginning, in relation to the “explanatory processes”, within the scientific debate of his time. Indeed, Bateson was about to upset the Cambridge anthropological precepts (Malinowski‟s in the first place), exclusively based on the “function” of events, the explanation for which he found oversimplified, narrow and teleological (for example, natives who seed to eat the plant, and so forth). His master retorted by attacking young anthropologists responsible for the fact that “new standards are being hoisted every few months and the reality of human life is being submitted to some queer and alarming manipulations”.20 Reverting to the Sepik river, called “the great Sepik” by natives, it is to be noted that Bateson was not happy with the observations made up to then (it was 1932) because, in his opinion, they were too formal and too far away from “the nature of meaning and explanation” that, later on, he would illustrate. These observations concerned an obscure and complex rite named “Naven” which the Iatmul celebrated every time an adolescent accomplished an adult act. In relation to this issue, the two Anglo-American anthropologists gave him the opportunity for a debate and for receiving new methodological feedback, necessary to spare himself another setback, following the one suffered with the Baining in New Britain. In her work (1959), Ruth Benedict, who studied under Boas,21 argued that both personality and the so-called criteria of normality are influenced by culture and attempted to define some dominating personality patterns. This flurry of ideas and people provided the background against which Bateson‟s only monographic22 anthropological work was written, one that some critics view as the least successful. I shall dwell on this work because, in my opinion, it still holds much importance and relevance, despite its grey areas (Italy is currently experiencing a renewed interest in certain key concepts, such as schismogenesis; see Pizzini 1990 and Ugazio 1998). Naven may certainly be regarded as a “clumsy” work, but, still today, it is rich in reflections, openings and references, useful especially to those who carry out field work and

20

Firth, R. and Malinowski, B. (1983; first printed: 1936). We, the Tikopia: A Sociological Study of Kinship in Primitive Polynesia. Stanford, CA: Stanford University Press. 21 Franz Boas played a crucial role for anyone who, in times of dictatorial rule, opposed the theories based on racial superiority which were supported also outside Germany (Boas‟s books were burned down by the Nazis). In his major work, The Mind of Primitive Man (New York; London: The Free Press/Macmillan, 1965), whose first version dates back to 1911 and the final to 1938, Boas argues: “There is no fundamental difference in the ways of thinking of primitive and civilized man. A close connection between race and personality has never been established. The concept of racial type as commonly used even in scientific literature is misleading and requires a logical as well as a biological redefinition.” 22 Naven, a term after which the book is titled, is what the Iatmul call a complex ceremony made up of many rituals, during which one can observe the “strange and bizarre” behaviours that Bateson continuously relates to the structure and the functioning of the culture of this people and their ethos. “At this early stage, I wish to make it perfectly clear that I do not regard Ritual, Structure, Pragmatic Functioning and Ethos as independent entities but as fundamentally inseparable aspects of culture. Since, however, it is impossible to present the whole of culture simultaneously in a single flash, I must begin at some arbitrarily chosen point in the analysis; and since words must necessarily be arranged in lines, I must present the culture, which like all other cultures is really an elaborate reticulum of interlocking cause and effect, not with a network of words but with words in linear series […] I shall first present the ceremonial behaviour, torn from his context so that it appears bizarre and nonsensical; and I shall describe the various aspects of its cultural setting and indicate how the ceremonial can be related to the various aspects of the culture.” (Bateson, 1958, p. 3).

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are concerned with building connections between different disciplines.23 It is likewise useful because it helps reflect on the attitude to take towards the “others than oneself” (a very topical issue) and for its new/old chapter on therapy meant as narration, an opportunity for reconnecting to one's “origins”. Reading Bateson, the anthropologist, with the aim of approaching therapy as an anthropological construction is neither a joke nor a theory. Indeed, it is an invitation addressed to the therapist/builder to observe new realities and new meanings in a spirit of research/discovery. Goffman (2005, p. 1) describes the therapist/patient/client interaction as an encounter which entails, inter alia, a series of very close connections with “the ritual properties of persons and the egocentric forms of territoriality”. So, what are the investigation tools that the third millennium worker can include in his therapeutic bag, borrowing them from the world of human sciences that the British anthropologist embodied so well? In other words, does it make sense to read this book today? It does for a number of reasons. First, it has a genuinely ethnographic character – absolutely innovative at the time and relevant and stimulating today – and, second, the references to the author‟s personal experiences have greatly impacted on the subsequent epistemological debate. Moreover, the work contains insights based on observation, or rather hints on how a researcher should observe reality during his field work, that is, by replacing in his mental lexicon “or/or” with “and/and”, something that still today fails to be applied in certain scientific domains. As Geertz maintains (1973), the writing/narration makes the anthropologist an “author” and a maker participating in every perceivable element, and not only in his works. Hence, a thoughtful writing, an uninterrupted and deep dialogic relationship between the author and the text that acquires the value of a thick description. The anthropological work acquires “interpretive significances” (Geertz, ibid.) and the account becomes, at once, richer in creativity, rigour and imagination. Therefore, Bateson‟s first work, the most properly anthropological one, holds more than a merely historical-biographical relevance: it is a hermeneutic operation, that is, one directed towards other concentric circles of thought, such as those developed by Heidegger,24 Goffman (2005), and Rorty (2007). In this regard, it is remarkable that Rorty, a philosopher from Virginia who advocates a “philosophy without mirrors” (1979), gives so much attention to the small sign, the fragment 23

The work, first published in 1936, and whose complete title is Naven: A Survey of the Problems Suggested by a Composite Picture of the Culture of a New Guinea Tribe Drawn from Three Points of View, was continuously revised and updated, as Bateson felt the impact of other sciences (mathematics, cybernetics, etc.), until 1956, when the final edition was published, with a foreword and an epilogue which, as suggested by ethnoanthropologist Sobrero (L’antropologia dopo l’antropologia. Rome: Meltemi, 1999), aimed at “witnessing the originality of Bateson‟s path and relating it to „these new ways of thought which were dimly foreshadowed in it‟ ” (p. 172). Indeed, with regard to the integrations, reflections and questions that the text continuously poses to its author (who, thus, feels compelled to update it all the time), Sobrero maintains that “what is important is realizing that naven is a metalogue […], a permanent questioning of „types‟, a continuous process through which society restores its balance, just like Bateson‟s book, Naven, a continuous alternation of a question that the natives‟ „explanation‟ raises, a possible answer on the part of the anthropologist, a shifting of levels, a new question” (p. 179). 24 On the relationship between Heidegger and Bateson, see: Mazzarella, E. (1981). Tecnica e metafisica. Saggio su Heidegger. Naples: Guida. The author points out the common features to the systems of thought of the two remarkable representatives of the XX century, especially the “wisdom of a consciousness which is systemic in Bateson, whereas to Heidegger it‟s the wisdom which knows to be rooted in the hermeneutic circle of unveiling, where every answer already presupposes having been called, that is, being referred to a „Power greater than the self‟ (as Bateson would have it)” (p. 318). The common aspects to the two lines of thought are also examined by A. Wilden in System and Structure: Essays in Communication and Exchange (London; New York: Tavistock Publications, 1972).

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(weren‟t “fragments of behaviour” what was observed by Bateson?), the detail, the shade, whenever he observes a given social fact. In his research Rorty considers writing as the freest means of expression to describe an event or a story. Narration is to be seen as a metaphor, the free expression of thought (and here lies another similarity to the British anthropologist), the possible opening to further connections, a resource for new constructions. Finally, it is a sort of incitement to open the door, also by using rationality in a different way. Indeed, to Rorty “rationality is roughly synonymous with tolerance” (1992), a very topical issue today when we “say” that we live in a multiethnic and multicultural society, and yet we find it difficult to change our habits or our attitudes to remake ourselves into a new kind of person aiming at something different than before (Rorty, ibid.). Going back to Gregory Bateson and Naven, it is to be noted that, as an ethnographic work, the essay presents yet another interesting aspect: it allows new departures that, by advancing in a circular way, make us go back to ourselves. Bateson‟s way of writing, or rather describing – in itself, an abstract operation –, does not always succeed in conveying all that he has observed on the field. Consequently, the narration takes on a spiralling shape, made up of a number of circles that relate to one another and simultaneously restrain and open new spaces. Bateson‟s non-compliance with certain research criteria has certainly contributed to the precarious asystematic nature of the book, but has also provided new opportunities for studying a ritual that, after all, will never be completely disclosed. Indeed, the philosopher of nature is so very right when he argues that the word “culture”25 does not connote anything, being, as it is, an abstraction, a label “for various points of view which we adopt in our studies” (Bateson 2000, p. 64). By now, the Iatmul have probably disappeared as have their rituals – more or less cryptic, yet to be deciphered.26 What remains is the whole of the Batesonian anthropological lesson, intact and not yet fully learnt. Just like the British anthropologist who, though with many errors and meta-levels, promoted new modes and new “attitudes” to observe other phenomena in countries other than his own, we have the opportunity to start this new millennium by proposing new attitudes of the mind, new epistemologies towards the cultural “events” just coming to the fore. The anthropological fact, the object observed for such a long time, is among us: it has been “disclosed”. It is no longer exotic and far away. It is amid us, not only as a different complexion or religion, and therefore as something visible, but as something which is always inside us, whenever we come into contact with someone or something “different” from us, or rather “other” than us. What needs to be done is changing the position of our thought/action, in order to understand phenomena, such as migration, without resorting 25

Also other authors, such as R. Wagner (The Invention of Culture. Chicago, IL; London: University of Chicago Press, 1981) and R. Rorty (A Pragmatist View of Rationality and Cultural Difference. In Ames, R. T. (ed.), Philosophy East and West. Vol. 42, pp. 581-596. Honolulu: University of Hawai‟i Press, 1992), provide an original contribution when they argue, respectively, that “culture is not a given that shapes the lives of the people who share it” and “culture is simply a set of shared habits of action, those that enable members of a single human community to get along with each other and with the surrounding environment as well as they do”. I could report so many other definitions of culture, but I shall confine myself to note that current debates and conferences continuously make up definitions and concepts which more often than not are just empty containers, and, among them, the concept of culture plays a major role. In the past, the situation was very different because there were many primitive populations to study and, thus, their description by means of cultural enunciations was granted: there were plenty of so-called laboratories, and colonies were an ideal place for investigating. On this point see, inter alia: Lavodrama, P. (1998). Les usages politiques de l‟ethnicité. In Sud/Nord – Folies et cultures. (No. 9: L’identité), p. 89. Marseille: Éditions Érès. 26 We have no more news on them.

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to easy labels, that, being based on different ideological viewpoints (are they still there?), risk taking on a bias or being purposely misused. Indeed, we are confronted with a complex, multi-levelled, and multi-challenging phenomenon: left-, right- and centre-oriented behaviours are often “cross-party” attempts to push out-of-the-ordinary events into obsolete schemes that hide old prejudices and a new powerlessness. It is necessary to create new grids where the hermeneutic meaning27 of this encounter/confrontation with the other can fit in. We have to prepare ourselves – in a “politically neither correct nor incorrect” way – to start the slow distillation of a new approach to observation/research/intervention that any complex phenomenon requires. This also applies to the multifaceted world of systemic therapy/consultation which needs a renewed energy that the use of the same, though effective, paradigms, all too often seems to stifle. Systemic therapy needs to “put its wheels back on” and become “nomadic” again. The place where it is practised has to become a sort of “caravan” ready to wander across all new realities where socio-economical, cultural and therapeutic levels intersect to such a degree that the usual modes of intervention get confused. Maybe it is necessary to regain the “spirit of research”, whose possible extinction Selvini Palazzoli (an indisputable master for us all) announced back in 1979, during the conference “Present Imperfect” held on the occasion of the 4th Don D. Jackson Memorial Conference, in San Francisco, when she claimed to be convinced that any research, once completed, was already dead and gone. In her view, family therapy based on the systems model was an investigation method still in its infancy, exactly in the sense that Bateson meant when he gave one of his books the title Steps to an Ecology of Mind. To her this was a sort of sign showing a certain direction, a path with many obstacles that would hopefully inspire generations of scholars to search for something completely new. She saw a serious danger lurking in the field of family therapy: the loss of the spirit of research. She noted that the situation in her times was very different from the past, not only in Italy but also in other European countries, where many young people were waiting to become family therapists, and yet completely lacked intellectual curiosity. She added that unemployment was widespread among the young, as was much insecurity. Hence, an understandable feeling of urgency to learn some technique in order to be able to do something…28 The British epistemologist reminds us of how rich and wide-ranging transitions across human and life sciences29 are, transitions that reductionists often try to force into increasingly stifling passageways. At the same time, he drives us to reflect on those whose work entails much observation, that is, anthropologists and psychiatrists, and what happens when a mental organization meets its own products. At this point, it is useful to relate the description that Bateson gives of the psychiatrists‟ attitude in one of his works30: among today‟s psychiatrists, some usually think in merely Aristotelian terms, that is, according to an epistemology inherited from ancient Greece; others try to think exclusively on the basis of an epistemology more similar to that of Wiener and Korzybski; others – the greatest part – do not concern 27 28 29

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In the sense, meant by M. Ferraris, of “art of interpretation as transformation, rather than theory as contemplation” (Gaglione, G. (ed.) (2006). Studi Junghiani. Vol. 12, no. 1. Milan: Franco Angeli). Selvini, M. (ed.) (1988). The Work of Mara Selvini Palazzoli. Northvale, NJ: Aronson. (Originally published as: (1985). Cronaca di una ricerca. Rome: La Nuova Italia Scientifica.) Cf: Borutti, S. (1999). Filosofia delle scienze umane. Milan: Bruno Mondadori. The author investigates “the procedures” that make the “objects” being researched appear as such, and criticizes a certain scientific approach which is only aimed to data construction and objectification. Bateson, G. and Ruesch, J. (1951). Communication. The Social Matrix of Psychiatry. New York: W. W. Norton and Company.

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themselves with epistemological problems and in their expressions a complex blend of epistemological premises is implicit, premises drawn from all the various phases of the Western thinking of the last two thousand years. Bateson himself had found a direction to take, a method to build, not an enclosure (Ancora 1987). This historical feedback could provide a starting point, especially to those who are prey to concerns of an interventionist nature. Anthropology would then represent a possible link between “origins” and a multifaceted future, a way to give attention to shapes and meanings that particular moments of contact/contagion/contamination would create, in the form of disorder and evolution, “mestizoed chaos”, or a new organization. In this framework the clinical encounter could be a cognitive and exploratory continuum interspersed with “boundaries” and “thresholds” to get over or maintain. The therapist would become a builder of dialogic realities in the same way as the shamans or the traditional healer: the West and the East, both rigid structures, would become, once again, two “ideas”, as Jung31 stated. In this light, Naven and the whole of the anthropological research carried out by Gregory Bateson cannot be reduced to the mere concepts, albeit fundamental, of schismogenetic processes and “symmetric” and “complementary” relations (these relations have been regarded by some as the examples of the value of a given communication: negative and positive, respectively). The question that I wish to raise is a different one: stimulating “off the subject” and “out of context” reflections, as well as a “shifting of levels”, in order to develop a way of thinking that is free and ready to further associations. It would be a real shame if, in the name of a strict and alleged preservation of paradigms, one decided to parade one‟s scientific neutrality (as well as “pragmatic theories” or problem solving) thus reducing scientific debate merely to the search for “modern techniques”. Reverting to what Selvini Palazzoli recalled, it is clear that systems thinking needs to be re-vitalized, to better re-use its own premises. This approach is necessary to deal with issues (that shall be discussed later on) such as subjectivity, context and transcontext, the social and cultural self, the “nomadic” course of identity and treatment, and to learn how they can be put into possible and, especially, usable frames. Bateson‟s path helps us understand the twofold (old/contemporary) value of transcultural science which, though rooted in the past, turns itself towards today‟s phenomena. Though it is true that we tend to follow a line of thought outlined, among the others, by Gramsci which is based on the possibility of a theory/practice/theory, still, in the wake of Alfred Schulz‟s social phenomenology, such sociologists as Berger and Luckmann (1967) maintain that theories can no longer be considered as statements made by science in a negative or positive sense, but, rather, as the legitimization of a construction of reality – deep and meaningful enough – in modern society. Such analysis should spontaneously set aside the topical “scientific validity” of these theories and consider them merely as “data” to understand the subjective and objective realities which they come from and sometimes influence: human reality is a socially constructed reality. Thinking transculturally, thinking systemically and vice versa: theoretical-clinical experiences across different cultures are a source for new associations. Valeria Ugazio (1998, p. 42) rightly notes that “theories generate reality” (after Berger and Luckmann 1967). And yet, in turn, social realities generate theories. Besides, Bateson stresses how important it is to

31

See: Clarke, J. J. (1994). Jung and Eastern Thought: A Dialogue with the Orient. London; New York: Routledge.

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build bridges across life sciences and human and social sciences,32 fields that some wish to separate by means of a science based on a “representation” of the world objects, with the aim of explaining, objectifying, manipulating, and managing them. This operation can be performed even remotely, far away from the objects to observe, under the pressure of the most urgent needs, as remarked by Latour, in Science in Action (1987).33 The conflict between this desire of life sciences and “the understanding of phenomena which typically belongs to human sciences” is not recent. In this regard, Bateson, as craftsman and engineer, invites us to re-group and re-connect links and relations among apparently distant worlds as an evolutionary challenge. By leaving to others the problem of addressing the issue of “coherence” raised by Naven (a past and present concern for “purists” in anthropology and other fields), Bateson focuses instead on “incoherence”, boundary areas, where contamination of paradigms and people is possible. Hence, an evolutionary chaos, as the principle that generates spontaneous and temporary orders with recurrent adjustments, distilling our world view, our individual style, and enabling us to see the differences (it would be impossible not to consider the continuous adjustments and afterthoughts, as well as the final incompleteness, as some of the most intense traits of Naven). That is why, to anyone, like me, who works in cultural, pathological and epistemological borderlands, the lesson coming from far away, from the Sepik river, still retains its full significance. This holds true not only on account of such fundamental concepts as the symmetric and the complementary relations, the observer‟s “position” in the observation process, and the analogical transposition from a science to another, but also because of the invitation/the need to highlight spaces that are increasingly permeable to different contributions, without monopolizing the thought: a passage “across” our own attitude, our own world view, whether strict or flexible. Science connotes the thinking by which it is connoted. Bateson, the philosopher of nature (at scientific conferences choosing a definition to introduce him was always very difficult, because he dealt with plenty of disciplines), whom I have defined as a “mestizo” – due to his mixing, transposing and crossing of many different fields –, sums up this fluidity: “As I see it, the advances in scientific thought come from a combination of loose and strict thinking, and this combination is the most precious tool of science” (Bateson 2000, p. 75).

1.3. EPISTEMOLOGICAL BOUNDARIES “ „Shall we play a game?‟ The Chinese did not wait for an answer. The chessboard had already been laid on the low table with its thirty pieces on top of it. As always, the water of the Huang Ho separated the two armies. Infantrymen, mounted soldiers and artillerymen were waiting for the signal to invade the enemy territory while elephants, unable to cross the borderline that divided the battlefield in two halves, powerfully trumpeted one another in challenge. Withdrawn in their unsafe fortresses, surrounded by useless mandarins, both emperors sought to postpone the moment when they would find themselves face to face. The clash was about to start once again, the game would repeat itself once more.” The pattern on the chessboard defines the symbolic projection of space where the game is played, that is, a 32 33

Cf: Borutti, S. (1999). Filosofia delle scienze umane. Milan: Bruno Mondadori. Latour, B. (1987). Science in Action: How to Follow Scientists and Engineers through Society. Cambridge, MA: Harvard University Press.

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single and abstract open field. “Unlike in the Indo-European tradition, in the Chinese one pawns do not fill an area, but are placed on junctions, that is, the intersection points of the lines along which they are moved. They outline a path, whereas the Indo-European ones define a position […] The Chinese chessboard can be regarded as the prototype of a divided and disputed space: it‟s around a clearly defined border that the game is played.” (Zanini 1997, pp. XI-XIII). Actually, it is to be added that a boundary, a frontier does not merely represent a line separating two territories: indeed, sometimes it is only by dividing that “other spaces”34 can be defined. This concept is likely to date back to the time when, in a particular phase of the evolution of society, men attempted to peacefully define rules and property rights in disputed territories. Once set, within a certain social structure, these rules were organized in standards and regulations in a peaceful way (this aspect is worth of emphasis). Later on, since the borders of these territories were not clearly outlined, larger groups claimed them. This part of history may not necessarily be viewed only from the point of view of conflicts: what was at stake was not the possession of a land, but rather the control over a moving line, an almost ideal one, a frontier. It is to be noted that frontier is one of the few Western words stemming from late Latin: frontiera, fronteria or fronaria, i.e. a region placed in fronte, that is, at the margins, which is quite the same in Spanish (frontera), in French (frontière), and in Italian (frontiera). This line separated peoples only in an abstract way: indeed, they continued to be part of a larger single group. This concept – at once spatial and historical35 – allows us to better understand epistemologist Serres36 when he argues that the first priest who, holding one end of a rope, after enclosing a piece of land, found his neighbours happy with the borders of their common fence, was the true founder of analytical thought and, consequently, of law and geometry. Through the fixed nature of the contract (whose validity lasts for a long time), the exactness and the precision of the drawing and the correspondence between the accuracy of the former and the stability of the latter, terms and values become more definite and the parties find themselves separated in an exact way. These prerequisites typify both the contract drawn up by a jurist and the one which science stems from. That is why the meaning of frontier/boundary/border is strictly connected to its ambivalence: a line – or rather a strip – that allows and forbids at the same time. In other words, it is a fundamental and osmotic interface,37 permeable to fields and yet rigid, so as to confirm their firm and unquestionable criteria. The uniting and separating nature of the boundary – applicable not only to physical and virtual spaces – gives it a social, political, psychological and transformative value (apart from

34

P. A. Florenskij (1892-1943), a Russian mathematician and an orthodox priest, employed the concept of ulteriority to mean the “tension towards something that lies beyond our intellectual faculties and whose presence is yet perceived” (cited by Tagliagambe 1997, p. 266). 35 Cf: Karahasan, D. (1995). Elogio della frontiera. In Flores d'Arcais, P. (ed.), MicroMega. No. 5, NovemberDecember). Milan: Somedia - Gruppo Editoriale L'Espresso. See also the concept of frontier in: Zientara, B. (1979). “Frontiera”. In Enciclopedia Einaudi. Vol. IV, pp. 402-414. Turin: Einaudi. 36 Serres, M. (2002). Origins of Geometry. Manchester: Clinamen Press. (Originally published as: (1993). Les origines de la géométrie. Paris: Flammarion.) 37 Of the many meanings attributed to this term, I refer to the definition given by G. Bateson and M. C. Bateson in the glossary of Angels Fear (Chicago, IL: University of Chicago Press, 1988), where interface is defined as a general term indicating the surface that is formed where two domains (which may not be closed) meet in transaction and replacing the notion of boundary for three-dimensional elements or sets. Bateson employs the term interface to refer to the interaction between systems which may not be completely closed or limited: he

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a geographical one). One need only think of the many boundary lines – from the Gothic line to the Berlin wall – that, in the past, have defined not only spaces, but also cultures, ideologies, and especially peoples, individuals and their thoughts. The issue now is recovering the sense of mobility and differentiation, rather than that of exclusion and separation, that this word encompasses. In this light, referring to the title of this chapter, there exists the need for a real “epistemology”, that is, a mobility of thought, an opportunity for “knowing knowledge” (Morin 1992), “a branch of science combined with a branch of philosophy” (Bateson 1979). Here the terms “border epistemology” and “border-crossing epistemology” (as an area of knowledge across many others) refer to the self-referential cognitive processes that start whenever we experiment, overcoming mental barriers and crossing impure territories, where the “boundaries of the self” extend and stretch to realize their full potential and multiplicity. For that matter, isn‟t culture, inherent in social sciences, distinguishable from its classical and humanistic interpretation because of the conspicuous expansion of its contents and, thus, its boundaries? Isn‟t it through a very thin slot that we can often reflect on the boundaries of our daily normality, whenever we are faced with psychopathological events? And in anthropological contexts, in ceremonies, isn‟t the officiant at once separated from and joined to those assembled by a boundary? Laying boundaries outside often means erecting them also inside, which results in suppressing the spirit of freedom and imagination that expresses itself at its best in an “out of context” condition, a condition that is necessary for establishing new associations, especially when in our work immobility prevails. This also means setting limitations, that is, creating frames,38 thus accomplishing two simultaneous activities: exclusion and inclusion, disintegration and identification, belonging and uprooting, in the eternal interplay between the inside and the outside. If one wished to find other historical references from which the system of thought underlying the Western culture has developed, one could not do without Tacitus. For anyone who deals with the notions of “the others” and “other”, modes and worlds to establish a relationship with, and contacts between cultures, Tacitus is a clear example of what, in modern terms, could be defined as the “anthropology of tolerance”. Among the issues that come to the fore whenever different cultures encounter/clash, it is to be noted, in particular, what happens when an older and somewhat nobler culture – such as that of ancient Greece39 – is conquered by a stronger one, that is, the Roman. Also the Christian thought had an eminent representative in the realm of the anthropology of tolerance: Paul of Tarsus,40 who wrote: “To the Jews I became as a Jew […]; to those who are under the Law, as under the Law” (Letters to the Corinthians). Reverting to Tacitus, his Germania is not only a historical writing, but a means, then, borders defined by information exchanges or changes in encoding, rather than a system such as the skin. As such, the interface is the place of systemic interaction. 38 On the concept of “framework”, see Popper, K. R. (1994). The Myth of the Framework. London: Routledge; Bouveresse, R. and Barreau, H. (eds.) (1989). Karl Popper et la science d'aujourd'hui. Actes du Colloque de Cérisy. Paris: Aubier, p. 40; the monographic issues of aut aut titled Cornici (No. 269, 1995, by R. De Biasi) and Gioco e paradigma (No. 269, 1995, by G. Bateson); Bateson, G. (1956). The Message “This Is Play”. New York: Josiah Macy Jr. Foundation; Borrelli, D. (1995). Ironia senza limiti. La cornice nelle strategie della comunicazione. Genua: Costa and Nolan. 39 See: Tacitus (1942). Complete Works of Tacitus. Trans. A. J. Church and W. J. Brodribb. Ed. M. Hadas. New York: McGraw-Hill. 40 This Letter to the Corinthians (9, 19-20) shows, in particular, to what extent Saint Paul adopted the life style and the culture typical of the Greek-Roman world, in order to accomplish his mission.

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guide to unknown peoples, a travel journal, and a means to establish a relationship with “others”, whose limits and prejudices the author describes. Tacitus‟s description of the difficulties met by the Romans in crossing the seemingly inviolable borders of the regions inhabited by the Germans, is renowned. His is the description, in a way, of a “non story”: one account after the other of a victory that everyone expects and never occurs. More exactly, it is the account of a “non conquest”. By contriving a sort of synthesis, we could regard Tacitus‟s work as the description of a limit, a boundary line which is strengthened, protected, and moved forward, only to be moved back, at the end, to its initial position, with a precise aim: marking the end of a territory and the beginning of another. In this particular region, a story was happening that was the outcome of the coming into contact of two cultures, different habits and customs, and different behaviours. This “space in between” (or interface, in modern terms) was a common threshold for both territories because both peoples involved contributed to its definition. The borderland represented, therefore, a possible exchange, an example of continuous permeability, where the coming into contact of differences took on a value of enrichment and resourcefulness. If we leave aside our natural reluctance, we will be surprised to find that the various tribes living along the Rhine, whom Tacitus observed, were very much alike the Romans and had a great innovative strength, combined to the determination peculiar of those who enter history thanks to the extraordinary power of their culture, and not only the military! Indeed, the eminent historian wonders whether the label of “barbarian” given to these tribes is appropriate to understand their usages, habits, and typical features, that unfortunately the Romans have lost. He realizes that a new “attitude” is necessary. A more recent description of these issues can be found in The Chrysanthemum and the Sword41 by Benedict, where the American anthropologist describes the behaviour of the Japanese who, after the Second World War, as a losing power, were getting ready for a new significant change in their policy: the rejection of war. Resuming the path so far outlined, i.e. the search for elements that might help to create a true “border thought” or “border-crossing thought”, it is to be noted that every word, condition or concept positioned within a borderland always entails different levels. Some of these are created, whereas others are undone. One need only think of what takes place when different cultures come into contact and interstices susceptible to all influence are formed: tracing back their origins becomes a difficult task. Actually, in our clinical practice, how many times have we found ourselves “in the middle” of regions with blurred outlines, where areas of competence are violated more or less consciously? Perhaps, starting from this point, it is possible to talk of a true epistemology of the “crossing of boundaries”, where limits and freedom, metaphors and realities can finally be approached trustfully. While approaching these issues, what catches our attention is the representation of a space whose border is at once clear-cut and blurred. On the one hand, this space has its own characteristics, a specific identity through which it can be defined; on the other, the continuous movement, the fluctuation which allows exchanges of different kind disrupts the sense of identity and enables the formation of light 41

Benedict, R. (2005; first printed: 1946). The Chrysanthemum and the Sword: Patterns of Japanese Culture. New York: Houghton Mifflin. This text takes origin from the task entrusted by the American government to Benedict Ruth in 1944 to study the way of life, usages, cultural rules and mental attitudes of the Japanese, against whose country the United States had declared war. At the time this instrumental use of the research was very much criticized, even though the portrait depicted by the author is faultless and thorough.

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and shade areas. In these areas the absence of borders and limits allows the interpenetration between the figure and the background. If we move from this representation to reality, we shall realize that before us a process is under way which is neither mechanical or simple, but very complex. One need only think of what is happening or about to happen, notwithstanding an understandable resistance, inside the cultures in motion and related usages and habits, music and religions which, being at the heart of them, necessarily clash against all other cultures (Tagliagambe 1997, p. 259). Various elements contribute, each to its own extent, to defining this area of contact,42 at once symbolic and real, which is no longer a delimiting one. These elements provide the knowing subject with a complex idea of the world with which he has to come to terms, that is, the object of knowledge, on the one hand, and the real object, on the other. Here, the Jungian metaphor of pregnancy plays a fundamental role since, as remarked by Trevi,43 it underlines that the symbol is also a “cipher”, i.e. something where a meaning is concealed and the presence of which is revealed, whereas its nature is not and never will be. In this sense, the symbol does refer to something else. However, this does not happen in the same way as a signifier refers to a signified, but, rather, a signified informs the interpreter that there exists a hidden signifier: aliquid obscure aliquid in se ipsum abdit (everything secretly hides something important in itself). At this point the following question is to be asked: why are we so interested in such notions as limit-concept (Derrida 2000), boundary (Zanini 1997, Tagliagambe 1997), limit (Rella 1994), threshold (Marchesini 1996), frontier (Karahasan 1995; Zientara 1979), interstices (Gasparini 1998), and nomadic concepts (Stengers 1987)? Could the answer be that these are metaphors of possible modes of knowledge, encounters with the other and with oneself, new dialogic realities, areas of “tension” and generative potentials? Could these be metaphors of “ideally democratic” spaces, where two identities representing two different entities, such as cultures, people, the art, and objects with their own history, become a fundamental part of something different, losing certain parts in this transition and acquiring new ones? It is indeed true that along the border something final ends, an identity ceases to be, but, as Karahasan44 suggests, the frontier still belongs to the identity, and yet it is already 42

Concerning the meaning of symbol as “bridge” or “boundary”, there exist many examples, starting from the Greek root itself (sumballo, which means putting together, exchanging, establishing a relationship with each other). Jung notes that the symbol “presupposes that the chosen expression is the best possible description or formulation of a relatively unknown fact, which is nonetheless known to exist or is postulated as existing” (Jung, C. G. (1989). Psychological Types. In The Collected Works of C.G. Jung. Vol. 5. London: Routledge). The symbol stands for something referring to or representing something else that our daily life is filled with, a social communication means that unites and acts as a reference, a “psychic mediator” (in a sort of biological analogy) that, being “the representative closest to the conscience of the unconscious material, arouses most controversies on the delicate issue of interpretation” (Bartoletti, P. (1986). Mito e simboli. Bari: Dedalo, pp. 70-71). Concerning the meaning of the word symbol as “bridge”, I shall report Trevi‟s remark on the subject: “where there exist symbols, passages occur across originally disconnected zones and, hence, transformations and changes take place” (Il concetto di ponte simbolico nel primo Jung, in Metaxù. November 1991, p. 23, Rome: Boria). In the wake of the interest and the fascination that this term has always aroused, an association for studying this theme was recently established in Italy. Named Simbolo, Conoscenza, Società (TN: symbol, knowledge, society), this association was founded by Sandro Briosi and is headquartered in Siena, at the University Department of Philosophy and Literary Criticism. 43 Instrumentum symboli. In Metaxù. No. 1, 1986, p. 55. Rome: Boria. 44 In Sarajevo, Bosnian writer Dzevad Karahasan experienced the realization of a dream, i.e. living in a true multicultural and multiconfessional city, that unfortunately, later on, was completely destroyed (cf: (1994).

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something completely different as it is equally formed by the other identity that starts from here (1995, p. 153). And it is exactly here that enlarged and impossible spaces can turn into experiential areas where, as in a cocktail shaker, various ingredients are mixed to obtain an altogether different final product. Turner (1986, p. 61) underlines that these spaces enable “the decomposition of the culture in its constitutional factors and in the free or „ludic‟ rearrangement of these in every, and any, possible configuration, as bizarre as it may be”. In this case, too, the likely scenario is one of dramatization, a clash between two opposed poles and yet, at the same time, the arising of new and untested communication modes, a place where a culture finds a way to represent itself, to tell its story (also to itself), to try out new ways. This also encompasses the way we face the world, our own attitude. On this point, starting from the famous Batesonian metalogue45 “Daughter: Daddy, why do things have outlines?” (Bateson 2000, p. 27), Zanini remarks that “borders and frontiers are cultural constructions which can take on many different meanings. They are, at once, the confirmation and the rejection of themselves and the dichotomies and ambiguities that they give rise to. Hence, we do not really know, as shown by Bateson, whether there exist only us, with our thoughts, actions and behaviour which draw the outlines of things, or these things exist with outlines created by us and our will […] the ambiguity of outlines consists in that […] they are there, but they cannot be seen. At least so long as we are within them” (Zanini 1997, p. 28). In this light, “transculture” can also be defined as the crossing of limits and frontiers, as going past known areas to reach other ones, with recurrent interactions, transformative instances, in contact with what is found as well as what is taken back. Todorov (1996) notes that transculturation is the transposition of a new code on the old one without any loss of meaning, as if he intended to reassure those who, comfortable in their stable and safe position, were afraid to lose something during the dangerous, turbulent and disrupting process of knowledge. de Martino46 and Bateson, who might be defined as “border” men, were certainly not afraid of losses and “bumpy paths”, since, just like shamans (veritable “threshold men”), in their work both adopted an extreme position, interdisciplinary and metalogical, similar to that of the therapist/researcher. de Martino was regarded by Risso, among other things, as one of the fathers of transcultural psychiatry in Italy and elsewhere (Ancora 1997, pp. 94-97). de Martino‟s essay La fine del mondo. Contributo all’analisi delle apocalissi culturali (1997) is the most brilliant “militant” example of an investigation of the issue of the end of the world across the most Sarajevo, Exodus of a City. Trans. S. Drakulic. New York/London: Kodansha International). The author maintains that in a borderland two space entities, two time units or two units of meaning encounter; for the borderland to be identified as such, both these units will have to be there in the same manner with their respective identities and define the borderland to the same extent, as their meeting place (in MicroMega,1995, p. 46). 45 By “metalogue” Bateson meant “a conversation dealing with some aspect of mental process in which ideally the interaction exemplifies the subject matter” (Bateson and Bateson 1988). 46 The most innovative aspect of de Martino‟s research method was a multidisciplinary approach which led him to carry out his work through collaboration within a team. For example, The Land of Remorse: A Study of Southern Italian Tarantism (originally published in 1961 as La terra del rimorso) sums up the study that de Martino made in the Salento area, in the Puglia region, helped by a doctor, a psychiatrist, a psychologist, a religion historian, a cultural anthropologist, an ethnomusicologist (Diego Carpitella) and a documentarist. For further details on de Martino‟s complete works, see the bibliographical references.

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various scientific realms. The outstanding religion expert47 used to stress how important it is to find a place where “one could be in society without actually being in it”,48 thus showing his emotional “closeness” as a researcher on the field and his “detachment” as a scholar. By way of conclusion, I shall dwell on the well-known exchange of epistolary essays between Jünger49 (1989) and Heidegger, and, in particular, on Jünger‟s essay titled Über die Linie50 [“across the line”]. The line, limit, or extreme threshold that has been reached in the modern age is a real muddle, as complex and controversial as ever. Jünger locates it in nihilism, which he regards as the disease of his century. The author remarks how urgent it has become to cross the line – precisely because the furthest limit has been reached. I shall dwell only on a few concepts of the many that a wide and deep debate on the matter would necessarily encompass, attempting to relate them with the arguments I have supported so far. “The line is not the final end, the limit beyond which nihilism is overcome. It is, rather, within nihilism itself, as his middle point. The text is clear: the crossing of the line, of the zero point divides the show; it indicates the middle point, not the end. Safety is still very far away…” (from Volpi's introduction to the Italian version of the essays, published jointly in 1989, pp. 24-25). The message I endorse is indeed the invitation to cross the line, to search for new passages, to walk across unknown territories, which the author associates to new values, new clues of the mind and the perception of new phenomena. Deep changes are under way also in the realm of education, in areas common to different sciences. By way of example, Jünger mentions the fields where mathematics and life sciences overlap (in this, he is more optimistic than Heidegger who instead suggests focusing investigations on the present and the past, rather than the future) and invites us to open our minds, win over that paralysing caution which makes us “avoid even draughts”, and look ahead and step “across the line”. In this way, then, we will perhaps be able to see, in the middle of the welfare state, with its assurances, grants, benefits and narcosis, human specimens whose skin seems tanned like leather and whose skeleton seems cast in iron. According to the colour theory, they could be complementary figures; general neurasthenia

47

See: Cherchi, P. (1994). Il signore del limite. Tre variazioni critiche su Ernesto de Martino. Naples: Liguori. See also: Callieri, B. (1982). Quando vince l’ombra. Problemi di psicopatologia clinica. Rome: Città Nuova. Here the author recalls some memorable conversations with de Martino on issues about “the end of the world” (p. 48). 48 de Martino, E. (1961). Prefazione. In Jahn, J., Muntu. La civiltà africana moderna. Trans. G. Glaesser. Turin: Einaudi. (Originally published as: (1958). Muntu. Umrisse der neoafrikanischen Kultur. Dusseldorf: Eugen Diederichs Verlag.) (Published in English, with an introduction by C. C. Hernton, as: (1994). Muntu. African Culture and the Western World. Trans. M. Grene. New York: Grove Press.) 49 Jünger, E. (1950). Über die Linie. In Anteile. Martin Heidegger zum 60. Geburtstag. Frankfurt Am Mein: Vittorio Klostermann (pp. 245-283); Heidegger, M. (1955). Über “die Linie”. In Mohler, A. (ed.), Freundschaftliche Begegnungen. Festschrift für Ernst Jünger zum 60. Geburtstag. Frankfurt Am Mein: Vittorio Klostermann. Jünger‟s essay was issued separately by the same publisher in 1950, in a slightly longer version, under the title of Über die Linie. Also Heidegger‟s essay was republished separately, with no alterations, save the title: Zur Seinsfrage (Frankfurt Am Mein: Vittorio Klostermann, 1956). [A parallel English/German edition of this essay was printed under the title of The Question of Being, translated and with an introduction by J. T. Wilde and W. Kluback (New Haven, CN: College and University Press, 1958)]. In Italy, the two texts were published in a single volume: Ernst Jünger – Martin Heidegger, Oltre la linea (Milan: Adelphi, 1989). Trans. F. Volpi and A. La Rocca. The page numbers reported refer to the Italian edition. 50 Italian edition: Ernst Jünger – Martin Heidegger, Oltre la linea (Milan: Adelphi, 1989). During the XVI and XVII centuries going “beyond the line” meant trespassing the limit, established by international treaties, which separated old Europe from the new continent. Beyond the line the European law ceased to be and a new space opened up, completely wild and lawless (see: Ilardi, M. (1999). Negli spazi vuoti della metropoli. Turin: Bollati Boringhieri, p. 30).

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claims their existence. Everyone wonders about their schools. About their models. They will certainly be the most diverse… (ibid., p. 66). Drawing from this journey an invitation to reflect, one cannot but note that “Über die Linie” may also point to another direction, one made of depth, research, and exploration, as well as the ability to look “across”. All these aspects can be easily defined as “meta-levels of observation”. The boundary line is itself a continuous temptation to cross it, implying possible violations and fears – never assuaged – that freeze and stop thoughts on the threshold. Perceiving the threshold means acknowledging the existence of something “else” that frightens, eludes and fascinates us. This something can be, at once, material and spiritual, other than and similar to us, and, in any case, different from our starting points which are so familiar and which, precisely for this reason, we are never willing to renounce. This acknowledgement also implies knowing that, at this very moment, “the Hermes who lives inside us has to ask Hestia the authorization to enter; Hestia is the goddess of the hearth, of the entrance, who connects and separates two worlds, just like a navel, which represents a symbiotic communion and diversity at the same time. The recognition of the threshold is, accordingly, the prerequisite for dialogue. Uniformity does not enable dialogue.” (Marchesini 1996, p. 16 [Emphasis added]). Here is the “boundary” area, no more mythical, no more virtual, but with its own physicality that it acquires through the visibility of differences, mutual acknowledgement, and the recognition of the importance of “otherness” and others. This is the ground which is to be occupied by border workers, that is, all those who, having decided to cross a boundary, have to face continuous shifts of levels and slidings, as well as tiring around trips in territories where a specific clinical issue is not the only prop they can hold onto.

Chapter 2

THE CULTURE OF MEETING 2.1. THE JOURNEY BACK AND THE “RETURN” FROM OTHER CULTURES Where does a journey start? In his critical essay about Dostoevsky‟s work51 Mikhail Bakhtin writes: “The very being of man (both external and internal) is the deepest communion. To be means to communicate. […] To be means to be for another, and through the other, for oneself. A person has no internal sovereign territory, he is wholly and always on the boundary: looking inside himself, he looks into the eyes of another or with the eyes of another. […] I cannot manage without another” (Bakhtin 2003, p. 287). The essence of any journey is entering “otherness and others”, in a dialogic relationship, that disrupts all the “central viewpoints” from which one often pretends to talk (ethnocentrism, culture-centrism, and so forth). Whenever we start a journey we believe to have actually left: but, more often than not, ours is a false motion. Indeed, we always and only want to reaffirm ourselves, our own identity, our own selves. But identity, as we have already seen, is an unstable concept, which can only be perceived through a relationship, in an interaction that is often difficult. Todorov can help us examine the long-standing issue of the centre-periphery relationship, and in particular, the reasons why we cannot/do not want to renounce a centre, on which our attitudes of mind are based. Renouncing a centre is definitely difficult, but this is the only way to start shaping the idea of the journey: only through this renunciation can a dialogue start. The Bulgarian epistemologist continuously reminds us that “not only is the earth not the centre of the universe, but no physical point is so; the very notion of centre has a meaning only in relation to a particular point of view: centre and periphery are notions as relative as those of civilisation and barbarism” (Todorov 1999, p. 192). In his A Journey Around My Room, written in 1795, Xavier de Maistre52 describes an imaginary journey along the winding paths and the reconciling processes of his soul, in search for a world rich in philosophical reflections – at times subtle, at times deep –, whereas the armchair of the psychologist, for all his methods, has never inspired such journeys to professional analysts… (from an afterword by C. A. de Sainte-Beuve). Thanks to the 51 52

Bakhtin, M. M. (2003; first printed: 1984). Problems of Dostoevsky's Poetics. Ed. and trans. C. Emerson. Introduction by W. C. Booth. Minneapolis, MN: University of Minnesota Press. de Maistre, X. (2004). A Journey around My Room. Trans. A. Brown. London: Hesperus Press. (Originally published as: (1984; first printed: 1795). Voyage autour de ma chambre. Paris: José Corti.)

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“travelling” philosopher we find out that the world where we live actually starts in our minds: it‟s there that we can remain, and it‟s there that we can and have to go back. We will later see how, in my experiences, I have often preferred travelling taking my head with myself, even though, sometimes, I have attempted to put it aside! It is not in the least simple to immerse ourselves in a different cultural context: we are naturally inclined to breathe the cultural air of the place where we were born, which is also that of Bacon, Newton, Descartes, Galileo, and rest our gaze on stones and walls of churches, so dear to any believer. When we set out on our journey, no matter the direction we take, this “luggage”, that is, the historical past common to every westerner, can be very heavy to carry. Indeed, we can feel a desire to reject things which make our own essence, a desire that almost makes us scrape our skin off. The role of the “westerner”, in a permanent state of crisis, with his shoulders bent by his atavistic feeling of guilt, is not the only possible attitude. In order to come into play in a dialectical and not in a conflicting way, we should immerse ourselves completely, possibly keeping our clothes on, and then decide whether and what dry clothes to put back on. When I review my own experiences on the ground, I realize that the observations to take into account are many, particularly in view of their possible use during my daily clinical work. Every time I have been in contact with “others” charged with the same healing task as mine, although in different contexts, I have always endeavoured to consider the varied and multifaceted aspects of the relationship resulting from the encounter of two thoughtstechniques. This interaction connotes the kind of reality that the two parties contribute to create and reflects their respective attitudes. Relating what happens in these particular circumstances is not simple, but I will attempt to make the following pages as interesting as possible, by renouncing any belittling classifying intent as well as any excessive enthusiasm or undue praise. In analysing phenomena, two sets of grids shall be used: the anthropological theses by François Laplantine (1986) in whose view, whenever health is the matter, the metacultural dimension must be taken into account (that is, it can be found in any society as an actualized original variation or a “repressed” potential form), and the clinical work carried 53

out by Julian Leff who, among other things, referred to psychiatrists as “western healers”. Leff argues that such psychic disorders as schizophrenia are distinguishable by the same traits across the most diverse cultures and are common to all human societies, whether capitalistic, western, eastern, industrialized or developing. Clearly, our culture typically needs conceptualizing and verbally expressing its experiences, even though it is not always simple to transfer onto a piece of paper or by means of spoken words what happens in a particular context, whether it is a therapeutic session or the meeting between a western psychiatrist on a mission and an African traditional healer or a Siberian shaman. For example, the spiritus loci is something difficult to export and almost always impossible to describe in its entirety; there always (and fortunately) exists something that escapes our usual means of knowledge or our ways of learning. Indeed, phenomena strictly linked to altered states of consciousness, such as trance and ecstasy, are still in a phase of systematisation, a process necessary to analyse them properly. As Culianu (1992), a disciple of Eliade‟s, underlines, another myth to be demystified is the need for working not through the opposition of patterns, but in the full and mutual respect for the thought-technique which identifies every culture. In this regard, the experience carried out at the Fann university hospital, near Dakar (Senegal), is memorable. 53

Leff, J. (1997). Introduzione. In Ancora, A., La dimensione transculturale della psicopatologia. Rome: Edizioni Universitarie Romane.

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Henri Collomb,54 a major representative of transcultural psychiatry, who managed the hospital at the time, accomplished a daring integration: hospitalized patients were given the opportunity to choose whether to be treated by a doctor, a traditional healer or both.

2.2. THE BUILDERS OF REALITIES AND KNOWLEDGE: TRADITIONAL HEALERS, SHAMANS AND THE TARANTULA HEALER We are in Africa, surrounded by the “indifferent immensity of nature”, as Livingstone would have it, during the last century. We are close to the Victoria lake, a location with a high concentration of energy and the source of the Nile, the longest river in the world which, in this particular region, takes on symbols and values peculiar to places of worship. A few dozens of kilometres away from Kampala (Uganda) lies a village called “The Clinic”, where mental disorders are treated by traditional healers. Led by one of the many self-alleged guides in the area we go on an unannounced visit to the place. This is a very particular village: there is a masonry house where the first visit is made and, depending on the specific problem diagnosed, patients are invited to stay in wards, that is, huts or small rooms which, in fact, look like veritable cells. We see some faces showing suffering, some curiosity and some people intent on carrying out routine work. We are amazed at the sight of a smiling patient, whose feet have been tied to an iron ball, seemingly to “prevent him from running away”, says my guide, “and from making harm to himself and others”. The evil spirit who has seized him is thus held back, with the assent of the patient who does not show any sign of uneasiness or any feeling that we would regard as such.55 Now, let me dwell on the meeting with the traditional healer who is described to us as the head, or rather the medical director. Getting an appointment with him has not been simple, even though, during the meeting, he seems quite eager to “explain” his work, which he does in an almost pedagogic fashion. We attempt to leave out of our field of observation easy comparisons, permeated by a certain air of condescension. At one point, he interrupts our thoughts and says: “I work with the evil spirits who imprison individuals and when I realize that an evil spirit has stricken a whole family, I hold them all. I often use the dreams they tell me. The dream power56 is, indeed, a very powerful tool because it allows me to intervene on the negative thinking which holds the patient prisoner by changing the way he looks at things. I also employ herbs and music (in the small room where he receives us a large drum can be seen).” Actually, what is happening goes beyond the simple description of his work and we realize that we have to rely upon perceptive elements which elude our usual means of knowledge.

54

See: Collomb, H. (1973). L‟avenir de la psychiatrie en Afrique. In Psychopathologie africaine (IX, 3, pp. 343370). See also: Zempleni, A. (1980). Henri Collomb (1913-1979) et l‟équipe de Fann. In Social Science and Medicine (XIV B, 2, pp. 85-90). 55 We had the opportunity to visit the psychiatric hospital of Kampala - the only one in the whole of Uganda - where the organization was excellent (in the British style): extreme cleanliness and short hospitalization time (one month). During a conversation with the director, we learnt that the hospital worked in partnership with traditional healers who, according to him, could heal only patients suffering from neurotic disorders. 56 See also: (1996). African Traditional Healing (Chapter 2). In Ntomchukwu Madu, S., Kakubeire Baguma, P., and Pritz, A. (eds.), Psychotherapy in Africa: First Investigations. Vienna: W. C. P. Publications.

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What the traditional healer says is not aimed at convincing us of something: his is a conversation on even terms, among colleagues, who exchange with one another their different experiences. In fact, at one point, he interrupts the discussion and asks: “Are you here for the conference?” (referring to the conference organized at the time in Kampala).57 “And what about you? How do you treat your patients?” I answer: “We use medicines and, in certain cases, we work with all the family”. “Also my aides and I often call all the family members and keep them in a special hut. We talk first to the mother who, in our culture, is the most important figure of the family, and tell her that the evil spirit we have found causes suffering to everyone and, therefore, has to be kept under control here.” “How do you become a healer?” “One must complete a learning cycle lasting five to seven years, which is passed down over generations, to reach the first level. Then, there is the second level and, finally, one becomes a „director‟ like me. The village where the clinic is has welcomed us and made us available all its facilities. You see, in that hut down there we keep the various herbs and drugs that can sometimes help to calm one‟s spirit. However, what is really important is being able to get into a real relationship with all patients, also through their accounts or their dreams, to make them dream differently, in the attempt to alleviate their suffering. It is not at all easy for me to explain the dream power that every healer possesses. As to the place where we work, we are not welcomed in all villages: some people do not accept us and, indeed, persecute us, as has happened in other areas in Uganda. Here we have been accepted and so we have stayed also because, as you have certainly seen, we are giving work to many men and women living in the village. To stay at the clinic, patients are required to pay a fee.” During this conversation in a difficult English, aware that the language is important and yet is not the only means of communication with doctor Serwadda (that is what he asks to be called) and his group (here called family long live), we realize that the situation is changing. Now they do not only wish to answer questions, but are also eager to ask us some, since we all deal with the same issues. In addition to general information on who we are, where we come from, and so on, we endeavour to tell about our experiences and the complex relationship with patients. The atmosphere, which is difficult to describe, is filled with extraordinary sensations. One need only look around to get an idea of what it is like: patients mingled with villagers, western jackets and ethnic clothes, psychiatrists and healers, anxious visitors and curious inhabitants, all in an extraordinary kaleidoscope. A zibaldone58 where it is not necessary to always define roles and functions, and, especially, where the boundary lines between roles are vague, thus enabling unexpected and unimaginable explorations and approaches. An initial and initiation-like acceptance has already taken place (the journey, the visit, taking drinks together, etc.) and all the rest is a natural consequence, which necessarily goes through the delicate phases of mutual recognition and the acknowledgement of each other‟s dignity and work.

57 58

See Ancora, A. (1997). The Psychiatrist and the Shaman. In Acts of the First African Conference on Psychotherapy (Kampala, 24 - 29 November 1997). Giacomo Leopardi‟s Zibaldone is a large collection of notes taken day after day on the most different subjects: philosophical reflections, ethical considerations, linguistic research, and reviews of his personal experiences. This collection was not meant to be published: its author considered it as a source to draw on for his future works. Cf: Leopardi, G. (1997). Zibaldone. Ed. E. Trevi, M. Dondero, and W. Marra. Rome: Newton Compton.

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Finally, Serwadda stops the conversation and asks us whether we would like to meet the clinic guests whom he is about to visit. Most of them are waiting outside houses and huts, ranged in a certain order, as if ready for a parade: what is about to happen is, actually, a visit in the open, completely different from what one could reasonably expect. While talking to a patient, he also addresses us and tells us parts of the patient‟s story or about his own difficulty in finding the connection between a problem and its roots. Just a quick glance is sufficient to make us realize the depth of the relationship that the traditional healer has established with each single patient. His approach is very straightforward: open, accurate and also “physical”. He is actually “close” to each patient, even though the environment is extremely varied and distracting, difficult to interpret for us. He touches the patient everywhere, to show the spots on his body which cause pain or the areas where the disease takes its origin from. Following his moves, we see that he conveys both support and protection, succeeding in brightening even the most troubled patients. Making physical an invisible illness makes it eradicable and therefore concrete: there is nothing to be afraid of, even though one, the patient, cannot see it. All this takes place in an apparent chaos, in a disorderly and disorganized context which, however, does not disturb the healer in the least. He is increasingly similar to a conductor, who looks absent-minded or tone deaf only on the surface. Serwadda is actually working on the “ordering” and “organizational” levels of the marks which he detects (right at this moment, we are reminded of our theories on chaos and complexity). Doctor Serwadda is now working on a group of patients according to a well-defined spatial scheme: patients are ranged side by side, the most suffering ones are seated, whereas the others are standing at a certain distance. The healer takes on different approaches: there are patients whom he seems to envelop physically more than others, some whom he does not even look in the face, and some to whom he has explained how to take the prescribed herbs. Looking around, we can also see that certain patients are left in their rooms with only the slightest lighting because they still need to recover or “reassemble some of their parts”, as Serwadda explains before taking us to the public visit. There is also someone whose feet are chained together. “Free” to move around the village – although only by jumping – he is prevented from going far or having “unpleasant encounters”. This containment method arouses a lot of comments among us, especially among those who have worked in old psychiatric hospitals or in diagnostics and care units. Have we ever contained a patient? Why? To whose benefit? To ours? To the hospital‟s? We timidly ask Serwadda the reason for this method: we are told that it helps the patient not to succumb completely to the spirit who has possessed him and protects him from another attack by the negative forces. Here everything is always related to a physical representation of problems. Besides, judging from the patient‟s smiles, this method seems to have a reassuring and relieving effect, notwithstanding the doubts aroused inside and among us. And yet, the same old question remains unanswered: is understanding everything always useful and necessary? And through what means of knowledge? Ours? Theirs? Answering these questions is certainly not easy and probably, after all, unnecessary. What is important is keeping one‟s mind open in order to detect, in experiences and encounters, new ways of aggregating minds (Bateson 2000).

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Now, we are in Siberia, near the lake Baikal, that shamans59 consider as a sacred sea (they call it a sea because of its size and depth), so much so that they have to visit it at least once in a lifetime, like the Mecca for Muslims. It‟s an area full of energy. Before my departure, I wondered whether it would make sense to share my experiences at such an important conference (the first on shamanism in seventy years), before such extraordinary people: I would have preferred, instead, to use the time allocated to my speech to listen to the masters of ecstasy. But all encounter necessarily implies the involvement of two parties and I can‟t turn back. My contribution has to be considered within the context of the exchange between very distant worlds and attitudes. I shall report the highlights of my speech only at the end of the chapter because it seems important to me to dwell on other considerations first. In my previous journeys to this part of the world, I had the chance to meet a few shamans. In particular, near Ulaanbaatar, I met Doljin Kandro Suren, an incredibly wise and humane woman (among the most important shamans in Mongolia) and Nadia Stepanova (President of the shamans of the Republic of Buryatia, southern Siberia). My report is a sort of post-production (borrowing a term from the movie industry), that is, a work “after”, a real journey back, not only in spatial/temporal terms. Actually, my experiences in Siberia and Mongolia have been so “full of everything” to provide an almost inexhaustible repository from which to draw gradually inspiration and sensations that are not always possible to express and convey. First of all, why would a psychiatrist decide to go to Siberia, taking with himself a “mythical” idea of the shaman, learnt from books? What are the expectations of someone who permanently works in the realm of psychic illness? Is he ready to travel across his own mental universe, his prejudices and stereotypes, to test their substance, limits, flexibility, openness and resistance? I have already discussed about these questions elsewhere (Ancora 1996, 1997) by focusing especially on the journey there. Now, I shall dwell on the journey back, that is, what comes “after”, which shall be analysed from all points of view, including its impact on work, especially as far as critical patients are concerned. The encounters I have lived through have helped me, among other things, to reflect carefully on what parts of himself a therapist would be ready to challenge in such a particular journey of suffering, what changes he should expect to face, whether new reflections have emerged on certain “paradigms” so far considered as veritable milestones: 1) what a therapeutic relationship is; 2) what care is; 3) what mental categories we are willing to “suspend”; 4) what therapeutic

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The rich literature about Siberian shamans shows the interest that this theme has always aroused. It is to be noted that the role of shamans has to be included into a well-defined cultural and, especially, religious context. Shamans‟ extraordinary powers and techniques cannot be taken out of such a context. On the subject I recommend a work by Mircea Eliade which still holds its topicality: Eliade, M. (1972). Shamanism: Archaic Techniques of Ecstasy. Trans. Willard R. Trask. Princeton, NJ: Princeton University Press. See also: Hamayon, R. (1986). De l'initiation solitaire à l'investiture ritualisée. Le cas du chamane bouriate. In J. Ries and H. Limet (eds.), Les rites d'initiation. Louvain-la-Neuve: Université catholique, pp. 163-202; Hoppal, M. (1994). Schamanen und Schamanismus. Augsburg: Pattloch. By this Hungarian author I also suggest reading a contribution to the First International Symposium on Central-Asian Shamanism (20-26 June 1996, Lake Baikal, ed. I. S. Urbanceva). Moreover, I recommend: Capacchi, C. (1996). L’aldilà degli sciamani: il mondo dei vivi e il mondo dei morti nello sciamanesimo euroasiatico. Parma: Palatina; Ancora, A. (1998). Lo psichiatra e lo sciamano: l‟anticamera della conoscenza. In Attualità in psicologia, vol.11, no. 3, pp. 371-379; Corradi Musi, C. (1995). Vampiri europei e vampiri dell’area sciamanica. Soveria Mannelli (CZ): Edizioni Rubbettino; Krader, L. (1978). Shamanism: Theory and History in Buryat Society. In Dioszegi, V. and Hoppal, M. (eds.), Shamanism in Siberia. Budapest: Akadémiai Kiadò; Rossi, I. (1997). Corps et chamanisme. Essai sur le pluralisme médical. Paris: Armand Colin-Masson.

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context we would like to create and, at the same time, decontextualize in order to experience new ways of knowledge and contacts. In the framework of the similarities/differences between the shaman and the psychiatrist (on which theme the debate never seems to end, which shows how “involved” we feel on many levels), two important differences are to be highlighted. The first is the spiritual background of the relationship between the one who asks for help and the one who gives help in the shamanic mysterium; the second is a “customized” liturgical practice, that rules out the possibility of applying the same predefined formulas and standardized appeals or solutions to everyone. Shamans can adapt their skills to each specific situation and make requests that sound most unusual to us, such as asking the patient to sing (once, after an intense ritual ceremony, we were asked to sing our songs: we, curious visitors, arrived on tiptoe from all over the world, understood, only after a while, that this was a way to make us relax and open up other communication channels). The relationship that shamans establish is always focused on man as connected to his natural environment, which is the landscape of the soul. The relationship with spirits is also unique and these are not the same for all the shamans belonging to the same group. Shamans are pushed by their own powers into a veritable negotiation, long and exhausting, to enter impossible worlds (similar to the ones where our patients live) with counterparties, invisible and yet present, which are unique for each shaman. The resulting dialogue always involves three parties: the one who asks for help, his intermediaries who appeal to spirits, and the spirits themselves, of cities and the forests. The spirits of cities live in Ulan-Ude, capital of Buryatia, southern Siberia, and Ulaanbaatar, capital of Mongolia, whereas the spirits of the forests live in the area surrounding the lake Baikal, where the shamans‟ first symposium60 took place in 1996, after many years of repression on the part of the Soviet regime which made available health assistance even in the remotest spots of the country (Stalin himself had two surgery/dispensary cars built which, via the Trans-Siberian line, reached Vladivostok, on the Pacific Ocean). This preliminary description is important to understand that, unlike in other parts of the world, here medical workers are definitely available. Buryats have the opportunity to choose and, when in need of help, they turn to the people whom they have always felt closer to their traditions, culture and emotional world. Also the relationship between the psychiatrist and the shaman is based on mutual respect, as I could witness myself (1997). When Nadia Stepanova, other colleagues and I were actually invited to visit the psychiatric hospital of Ulan-Ude, thus granting our wish, we all were amazed. We couldn‟t believe that this desire would be actually granted, nor that a shaman would be our guide. It is worthwhile to describe some sequences of that unique and extraordinary visit. The hospital was decent (which was completely unexpected to us); doctors and nurses were all dressing white coats and the material conditions of patients and wards were acceptable. 1. Astonishment: The shaman and our psychiatric colleagues, all following the organicist school of thought, complain that neuroleptic drugs are in short supply.

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As already noted (Ancora 1997), the symposium was a very particular one. In the morning, purification and protection rituals (tajlgan) were celebrated in front of the lake Baikal, the sacred sea, as if it were an altar. In the second half of the day, fascinating and meaningful tales on the shamans‟ lives were told in the taiga, the Siberian forest.

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Alfredo Ancora 2. Astonishment: During this visit we learn that our colleagues have referred to and normally refer patients suffering from psychic disorders to shamans, recognizing their ability to use access codes to worlds forbidden to others. 3. Astonishment: During the visit to a ward that Stepanova has already visited, she suggests the release of a patient, hospitalized with a diagnosis of autistic syndrome, for whom she proposes a new diagnosis (diagnosis comes from the Greek word for “knowing through”): that of someone who has received a shamanic call (characterized, inter alia, by turning inward, withdrawal into oneself, inappetence, etc.). She explains to all of us psychologists, from the West and Siberian alike, that the patient is suffering because his relationship with spirits and his ancestors has broken and, therefore, he can no longer recognize the “signs” of the shamanic call.

It is to be noted that the mediation carried out by a shaman, a veritable intermediary, requires a great and continuous effort, 24 hours a day. The help that he provides also stirs up the “spiritual stagnation or psychic sterility” remarkably described by Jung.61 Moreover, he acts in a particular context, where all aspects of the shamanic universe interact to a different degree and with a specific energy with one another, always searching for the origin of psychic suffering. Here the anamnesis (from the Greek word meaning “to remember”) takes on a different meaning: stirring up and removing roots that have been broken, hindered from growing or neglected. Any good psychotherapist who has dealt with serious psychic problems knows how important it is to master the skills peculiar to clinicians specialized in “boundaries”, “the beyond” or “the threshold”, which allow, as with shamans, to make approaching/departing and dramatizing/ironical interventions with the aim to come closer to patients without encroaching them. On this issue, a question arises: don‟t both the therapist and the shaman shape a common story whenever the create new realities and connect them to their roots and origins, to the clan or nuclear/extended families? Isn‟t it for this reason that Ellenberger (1970)62 asks himself whether there are similarities between those who approach a mentally distressed person in a seriously deteriorated condition by attempting to contact the healthy parts of his personality and restore his self and shamans who track a lost soul, find it in the world of spirits, fight against the evil demons who have imprisoned it and take it back to the world of the living? Aren‟t there also similarities with what Searles would describe (1986) as a journey to the hell of the psychotic, that is, the opportunities/skills that have to be used to create connections with all that, though invisible, can be perceived through suffering and distress? By way of complementing what has been argued so far, even though on a different logical level, I shall add a final reflection, at once syntonic and synchronic. I wish to 61

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Jung maintained that “all creativeness in the realm of the spirit as well as every psychic advance of man arises from the suffering of the soul, and the cause of the suffering is spiritual stagnation, or psychic sterility”. (Jung, C. G. (1958). Psychology and Religion: West and East. Collected Works, Vol. 11. Edited by H. Read, M. Fordham, and G. Adler. Trans. R. F. C. Hull. New York: Pantheon Books). See: Ellenberger, H. F. (1970). The Discovery of the Unconscious: The History and Evolution of Dynamic Psychiatry. New York: Basic Books. See also, by the same author, Médecines de l’âme (Paris: Fayard, 1995), where a thorough description is given, inter alia, of the so-called “psychic healings”, from ancient Greece to the present day, as well as the concept of psychopathology within the western culture.

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underline the “principles of health and maturity” (illustrated by Indian psychoanalyst Kakar),63 whether sacred or not, traditional or modern, which support or should support any psychological treatment (in the sense of psyche/soul) and permeates both the practice and the thought of us therapists and the rituals and flights of shamans. It is an intense and circular world which all those who deal with “the invisible” and the deep hope to create. Reverting to my experiences in Siberia, I shall relate a few impressions which still today are, to me, a significant source for reflection. A few years earlier, in 1994, during my first encounter with Nadia Stepanova,64 an encounter which lasted many hours – at once deep, fascinating and demanding – I asked her many questions. We spoke different languages, but, evidently, the communication channels which we activated belonged to another level of communication. At a certain point, she asked me: “Before starting work, do you pray?” I did not answer. The questions that this one aroused were far too many! It is right from here, from this tricky question, that I shall illustrate my further considerations. Indeed religion concerns areas and bends which are deep-set and involve the risk of violating borders and losing oneself, that is, the existence of something which cannot be seen or perceived through our usual means of knowledge. It is something metalogical and “meta-daily” (also in relation to the clinical practice), something “beyond” which lies between the patient and the therapist and, actually, goes beyond their relationship, something that reminds of that sort of spirituality that we all experience in our lives, work and culture. What psychiatrist Bruno Callieri writes on this matter (1995)65 is fascinating: “Whatever the tradition which it inherits, whatever the doctrinal references, the term „spirituality‟ means and refers to a way of being of the existence for and according to the spirit, „another‟ life, which is inherent in natural life and which is supposed as impossible to be reduced to acts that define or characterize biopsychological behaviour.” Discussing about this issue is a very demanding task due to the many meanings and concepts involved and also because any reference to such a theme is, for many westerners, not only difficult to understand, but indeed vague, if not impossible to get to. Therefore, the following observations – no doubt, very limited – aim to describe the attitude of mind on which the behaviour and the work of anyone engaged in the varied universe of distress are based, a universe whose lived and present experiences are common to all countries and all cultures. It is right from this universe of pain confronted every day by the western therapist, 63

Actually Sudhir Kakar borrows this phrase from Heinz Kohut. See: Kakar, S. (1982). Shamans, Mystics and Doctors. A Psychological Inquiry into India and Its Healing Traditions. Chicago, IL: University of Chicago Press. 64 Related in Ancora, A. (1997). La dimensione transculturale della psicopatologia. Uno sguardo da vicino. Rome: Edizioni Universitarie Romane. 65 Callieri, B. (1995). Spiritualità e misticismo: inquieto confine tra religione e psicologia. In Attualità in psicologia. Vol. X, N. 4, October – December, p. 291. Rome: Edizioni Universitarie Romane. Different views exist on the complex relationship between shamanism and religion (some, including Eliade, do not even consider shamanism as a real religion), as it became apparent during a conference organized in 1996 by Carla Corradi Musi, professor of Finno-Ugric philology at the University of Bologna. On that occasion I had the opportunity to talk about my (modest) experience in Buryatia, and I stressed the deep spirituality which accompanied every ritual manifestation and joined officiants and simple onlookers. It is worthwhile to remind that shamanism is one of the oldest religious phenomena in man‟s history (cf: Culianu, I. P. (1991). Out of This World. Boston: Shambhala Publications, where the famous religion historian of the Chicago school argues that, based on ethno-semiological research on paintings in Siberian caves, shamanism could possibly date back to 1000 B.C.). Moreover, in certain areas of southern Siberia it is associated to other religious systems such as Buddhism (cf: Corradi Musi, C. (1997). Shamanism from East to West. Budapest: Akadémiai Kiadò).

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the traditional healer, the Siberian shaman, the African marabout, the Guatemalan shaman and all the others, that we can start a path with parts that are common to all. It is indeed true that each “therapist” uses his own system of thought and his technique, but all share at least one thing: they are builders of connections with the real world. They are able to join, reconnect, and develop the most hidden and invisible communication channels, and, from that moment of the encounter on, they can start a common history with recurrent “references” to ideas and emotions within this particular kind of relationship. No description can exhaustively and comprehensively explain what happens during a western therapeutic session or a shamanic ceremony. The encounter belongs to the one who creates it, where “creating” means building together, contextualizing particular, necessary, and unique moments, amplifying the dialogue so that it can develop in countless ways, moving on levels which are now metaphorical, now real and which chase each other, and crossing together uneven grounds. The effort is separating, as accurately as possible, the dichotomous elements contained in many of the fragmented and fragmenting principles by which our culture has been greatly conditioned, notably mind-body, nature-culture, thought-action, head-heart (the well-known western dualisms described by Culianu).66 All these experiences make us realize that the light of reason alone is not sufficient to explain and know reality. Maybe it‟s precisely here that the spirit originates: in a far away departing point (from Claudio Magris‟s essay Lontano da dove),67 in a non-place, an atopon68 rich in light and shade areas as well as delicate and invisible shades, where “even angels fear to tread” (Bateson and Bateson 1988).69 It is here that a sort of rebellion of the spirit against reason emerges. However, by setting out the terms of the question in this way one would risk to create a mental trap. Actually, once again, although in a different way, the same gap between a visible and an invisible part would be represented. It is not in the least easy to talk about something which cannot be seen, that is, to describe what cannot be described and attempt to condense it in words (no matter whether many or just a few), to relate it, then, to what is visible. But it is even less easy to attempt a conceptualization, a typically western pretension, as Nietzsche70 correctly underlines when he strongly challenges the system of thought of our civilization by emphasizing all the violence exerted by thought on reality. Perhaps, in our own limited way, we would do well to reflect on whether there exists, inside men, something that goes beyond what is sensible, real, and take it to another level, different and/or opposed. In this perspective, the spirit could acquire the connotation not of “something”, but of a veritable dimension of the interior experience, out of all definitions, inherent in the knowledge of things, as shamans never stop teaching us. This notion71 dates back to ancient times and is related to the word that characterizes the work of us psychiatrists; psiche actually means soul. Accordingly, we could sort of define ourselves as “healers of the soul”. 66

Culianu, I. P. (1992). The Tree of Gnosis: Gnostic Mythology from Early Christianity to Modern Nihilism. Trans. H. S. Wiesner and I. P. Culianu. New York: Harpercollins. 67 Magris, C. (1989). Lontano da dove. Joseph Roth e la tradizione ebraico-orientale. Turin: Piccola Biblioteca Einaudi. The Italian phrase “Lontano da dove” literally means “far from where”. 68 In Greek “what is without a place”. 69 Bateson, G. and Bateson, M. C. (1988). Angels Fear: Towards an Epistemology of the Sacred. Chicago, IL: University of Chicago Press. 70 Nietzsche, F. (1974). The Gay Science: With a Prelude in Rhymes and an Appendix of Songs by Friedrich Nietzsche. Trans. W. Kaufmann. London: Vintage Books. 71 Cf: Ancora, 1997, pp. 80-81, op. cit.

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Plato wrote that “just as one should not attempt to cure the eyes apart from the head, nor the head apart from the body, so one should not attempt to cure the body apart from the soul. And this […] is the very reason why most diseases are beyond the Greek doctors, that they do not pay attention to the whole as they ought to do, since if the whole is not in good condition, it is impossible that the part should be. Because […] the soul is the source both of bodily health and bodily disease for the whole man and these flow from the soul.”72 Health is nothing else but the final product resulting from the restoration of one‟s spiritual balance. Plato adds that the illnesses of the body, just like the ones of the soul, are always caused by an imbalance which leads to a condition contrary to nature; in other words, they are the outcome of an excess or a lack of elements. The correct treatment, thus, consists in sorting out things by eliminating excesses and faults and restoring the balance among all parts and between each single part and the whole that contains them. Isn‟t this process exactly the one that happens in a therapy: sorting out the pieces of the self in disarray, the fragments that the patient carries with himself in pain? This is a process that involves the risk of losing oneself, as well as the opportunity to find oneself on a different organizational level. Indeed, only by building suspended and fragmented elements, both temporally and spatially (as it happens to shamans when they are in a trance), can we pass onto the next step of the co-evolutive process that is therapy. Another term employed by the “other” workers is ecology, which is not to be viewed in its most common sense, but as a set of relations, a broad natural order that entails a balanced relationship with nature, something which certainly cannot be grasped by anyone who attempts to describe it using narrow definitions. In short, it is a vision that unifies the natural system with something increasingly orderly by means of small-scale, sometimes invisible, systems (on this point, in Steps to an Ecology of Mind, Bateson points out a meaningful and complex route).73 In the face of particular phenomena it is certainly useful to be able to detect the relations between a specific part and the whole which contains it, among disorderly pieces and a broader natural system. Our work as therapists requires that the patients‟ states of suffering be related to the whole system, or rather the ecosystem they belong to: their families, their social groups, and their beliefs. This holistic view is not simple to endorse in a world, whether scientific or not, which only tends to dividing, dissecting and hyperspecializing knowledge into branches and disciplines, signs and syndromes. We have learnt from shamans, healers and their prayers how to turn to nature and how to relate it to the wider context which man considers as “nature”. In remote lands, I have realized that the search for a continuous and difficult reconciliation fascinates all environments, just as it happens in the psychiatric activity, were we fight side by side with our patients in order to reconnect, inside them, those parts that never seem to stop clashing with one another. What shamans really do when they say prayers or invite someone to pray is encouraging to reflect on one‟s own actions in a more harmonious and natural way. The man-nature consonance and the balance between thought and action show precisely how we can come closer to ourselves, the one 72

Plato (1992; first published: 1973). Laches and Charmides. Trans. R. Kent Sprague. Indianapolis, IN: Hackett Publishing Company, p. 62. See also: Reale, G. (1989). E Platone scoprì l‟inconscio, riflessioni sui sogni e sulla salute del corpo e della mente. In Riotta, G. (ed.), Il Sole 24 ore (3 September). Milan: Il Sole 24 Ore. 73 In this Bateson is definitely a precursor. In the introduction to his famous Steps to an Ecology of Mind (2000, p. xxiii) the author writes: “The questions which the book raises are ecological: how do ideas interact? Is there some sort of natural selection which determines the survival of certain ideas and the extinction or death of others?”

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immediately next to us, and then the one next, and so on, in an endless process whose parts continuously relate to each other, acquiring depth at each successive step (as Nicholas of Cusa theorized in the XV century). An imbalance occurs when these parts position themselves in a mutually menacing and conflicting way. It is then that the relationship of man with himself and nature breaks up and suffering and distress emerge. Besides, what else is the final goal of our activity, but providing the individuals entrusting us their disorders and malaise with the tools necessary to change their view of life? Presumably, this kind of goal is common to all those who deal with human suffering, lost parts, and harmony to regain and rebuild. One point must be clear: in order to start a journey, together with someone‟s state of suffering, we have to prepare ourselves to come into contact with his most destructive and destructuring parts. In this respect, we can learn from shamans and all those who, with the aim of helping to overcome illnesses, first have to “get contaminated” and take the ill parts upon themselves, sharing and participating even in the most extreme phases. From my own clinical experience and my encounters with Guatemalan cimanes (shamans),74 marabouts from the Upper Volta region,75 Siberian and Mongolian shamans, and traditional healers,76 I have learnt that a single thread joins all these cultural and religious worlds which, in other respects, are very different and often remote from one another. It is in these areas, marked by moving borders, that an intense, unique and personal relationship is created between the person who asks for help and the one who gives it. Together, they build a new reality, with new preconditions for thinking and acting. This new way to look at problems necessarily implies co-responsibility on the part of the one who asks for help, precisely because this activity can only be performed together. Another important point to take into account is the need for locating the places, times, persons and things that are no longer balanced and are at the origin of the malaise. The aim is giving, once again, a unifying meaning to one‟s own story, often lived through in a fragmented way, that is, finding the bond to one‟s roots, often forgotten or neglected. Jung,77 a psychologist and a great thinker of the XIX century, long since brought our attention to these problems by quoting Lao-tzu: “All are clear, I alone am clouded”. Indeed, it is precisely Jung who, carried away by his admiration for spirituality, traditions and systems of thought such as Buddhism and Taoism, hinted at a kind of inner beauty and peace which can be achieved only through a difficult and rigorous self-analysis process. Perhaps shamans can teach us to observe the horizon through that third eye (the spiritual eye)78 which often frightens us and, thus, we want to protect ourselves from. By way of conclusion, I shall report the final part of the speech I held at the First International Symposium on Central-Asian Shamanism, in 1996, which I mentioned earlier on: …Now I wish to conclude this modest contribution of mine, first of all, by thanking you for the extraordinary opportunity you have given me to participate in this symposium. Among 74

Ancora, A. and Fischetti, A. (1983). La cerimonia rituale Maya. In Scienza 2000. No. 9. Ancora, A. and Fischetti, A. (1988). Lo stregone e lo psichiatra: dialogo tra colleghi. In Sanga, G. (ed.), La ricerca folklorica. No. 17. Brescia: Grafo. 76 Ancora, A. (1998). Psychiatrist and Traditional Healers like Builders of Reality. In Acts of the Congress of Psychotherapy in Africa. Kampala, November 1998. 77 Clarke, J. J. (1994). Jung and Eastern Thought: A Dialogue with the Orient. London; New York: Routledge. 78 Lobsang Rampa, T. (1956). The Third Eye. London: Secker and Warburg. 75

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other things, this has been an occasion to go back to certain times of my personal and professional life. By coming into contact with so many suffering people and finding, luckily enough, good teachers, I could learn that the greatest danger often lurks inside ourselves: it is our own way of thinking. Indeed, we have succeeded in pulling down large parts of the walls which for long have separated peoples and ideas (unfortunately others are still there). And yet, now, the risk is replacing them with large shop windows through which we can look at ourselves, but always and only from a distance and suspiciously. What we need is achieving a greater proximity, a new way of looking, and a broader contamination among ways of thinking and systems of thought, without fearing to lose the original purity. Today‟s meeting is an example of how we can overcome – and there‟s no doubt about it – fears dating back to thousands of years ago… (Ancora, A. 1996. Ecology of Mind, Ecology of Soul: A Transcultural Psychiatrist Experience. In Acts of the First International Symposium on Central-Asian Shamanism. June 1996, Lake Baikal, Buryatia; personal paper).

A pause for reflection is in order. The experiences I have related have some elements in common which need a closer examination, the main of which is the importance of the context. This consists in communities with clear-cut cultural identities which acknowledge the power of the shaman or the traditional healer and, in turn, are acknowledged by him. Every group is subject to established rules that strengthen traditions and culture and govern how to ask for help and delegate the healing power. The person who is empowered to care is likewise bound to this culture; indeed he is its main representative. Every ritual, every ceremony increases this power and, at the same time, strengthens the sense of belonging and protects the single individuals who ask for help as well as the whole group who, physically, is always present. Care, context, and culture are inextricably bound and refer to one another. All the interventions that I have had the chance to witness were characterized by an effectiveness which was not only symbolic, but also real (the outcome increases the power), and, consequently, those who turn to healers for help rely completely on them and their methods of treatment. Apart from fighting with or against invisible forces (whether negative or positive), healers make an agreement with the members of the ill person‟s family or the whole group who, thus, become irreplaceable links of the chain of the healing process and this becomes, in turn, a common path. Since the very moment when a person agrees to rely upon healers, he places his trust in them, by giving them a boundless credit, accompanied by great expectations and a remarkable proneness to believe. The term to believe is among the most difficult ones to transpose because it should be deprived of all “negative” connotations encompassed by its translation in our culture, as if “psycho-plasticity” were typical of “other” methods of treatment only. Whether direct, on patients or their families (even though keeping their interactions distinct is difficult in the cultural context where we work), or mediated by the body, music, rituals and the technical equipment contained in every worker‟s therapeutic bag, the therapeutic act always aims to create an influencing process. Accepting foot chaining (as witnessed in “the clinic” in Kampala) – physically and not symbolically – is also a way to interact, by restraining oneself from or constraining something that needs to be first tamed and then uprooted. The bodily/materializing aspect of the methods applied by African traditional healers and the spirituality/invisibility of the parallel worlds of Siberian shamans are linked by a thread which connects the action of care to its context. Besides having to mediate between worlds which often conflict with each other, healers have the task of treating in the broadest sense of the word, i.e. restoring the ill person‟s well-being, now lost, and “preparing” horizons apparently beyond reach. Healers have to reconnect every event to rules

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which have been violated, and also, more generally, to the meaning of existence, once existence itself is no longer under threat. To do so, they turn into “network workers” by asking an alliance from the family first, and then, if necessary, from the group and the whole community. It‟s not only the healer or the person asking for help who is involved: this powerful message must always be made visible and emphasized in all possible ways. It‟s the culture that claims this and it‟s precisely in the name of culture that the healer acts thus. The balance is therefore recovered and all bonds are reconnected: care, culture, family and ancestors are no longer separate worlds. By attempting an audacious transposition in our work, we could assume that the journey with the psychotic is a “typical” journey into the world of the other, with the fear to get lost, to go to pieces. This journey is also a leap into another dimension (I shall dwell on this point at the end of the chapter). Before concluding this chapter about builders of realities, I shall relate another encounter, that I consider extraordinary because it opens up a window on a particular reality: music and its therapeutic properties. It is difficult to consider the pair music-care as separated from the cultural context, indeed the study of music “no longer in culture, but as culture itself”. One need only consider the times of ancient Greece when any competitive activity, whether musical or therapeutic, was always performed within a religious and ritual framework. When such competitions took place, wars were suspended and each participant, though to a different degree, “felt” a particular involvement. At times the “inner” impact was so strong that it could cause a real upset, and, in certain circumstances, the healing of illnesses. This process is similar, in a way, to what happens during healing masses celebrated within some Christian cults: during these ceremonies the power of singing and music is often extraordinary79 and reach unattainable spots, freeing people from toxins and malaise. Music turns into a very concrete communication means which strikes without hurting, allowing detachment from a thought that is often reluctant to “ease”. Music can help to rebuild, within a given culture, the meaning of an obscure story, by using particular transmission channels, reserved to the sender and the receiver only. One need only consider the so-called tarantolati, that is, those who, believing to be pizzicati (bitten) by a tarantula (the spider after which the musical genre of taranta is named), could not recover unless through music. On this matter, Diego Carpitella80 provides an interesting technical and musical explanation. The rhythm produced by certain instruments (diatonic accordion, tambourine, and guitar) exacerbates the crisis, whereas the isometric rhythm produced by the fiddle has a checking and, especially, “containing” effect, along an established path which ends with the recovery from the spider‟s bite. Jung81 was reported to have remarked once that he was sort of irritated by music because it dealt with “such a deep archetypal material and those who play don‟t realise this”. In 1956, after meeting Margaret Tilly, a famous musician who carried out experiments on the 79

Gilbert Rouget talks about the right music and initiation. See: Rouget, G. (1985). Music and Trance: A Theory of the Relations Between Music and Possession. Chicago, IL: University of Chicago Press. (Originally published as: (1980). La Musique et la trance. Paris: Gallimard.) 80 Diego Carpitella is a foremost Italian ethnomusicologist. See: Carpitella, D. (1961). L'esorcismo coreuticomusicale del tarantismo. In de Martino, E. La terra del rimorso. Milan: Il Saggiatore, pp. 335-372. Also see: Carpitella, D. (1970). La recherche ethnomusicologique et la musique du vingtième siècle. In Yearbook of the International Folk Music Council, II. Canberra: International Council for Traditional Music. 81 This episode is related in: McGuire, W. and Hull, R. F. C. (1987). C. G. Jung Speaking: Interviews and Encounters. Princeton, NJ: Princeton University Press. It is also confirmed in: Watts, A. (1972). In My Own Way. An Autobiography 1915-1965. New York: Pantheon Books.

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therapeutic value of music, he wrote in wonderment: “I feel that from now on music should be an essential part of every analysis. This reaches the deep archetypal material that we can only sometimes reach with our analytical work with patients. This is remarkable.” Apart from suggesting references to a rich literature82 on the use of music in trance events and possession cults, I wish to emphasize how important these phenomena are to allow the release of energy. They represent real “passages” from blocked energy (the causes for which are due to different events, related to the specific cultural context) to a freer kind of energy. This embryonic transformational potential, which is a common trait of all rituals and, in a way, all treatments, finds in music its highest expression in terms of desire (rather than show), the overcoming of the threshold of suffering, and the opportunity for decentralization (or, indeed, a veritable “dissolution” of the centre). Music is, thus, a generating process which creates unexplored spaces of knowledge by combining different worlds in different places. Music is a place of contaminations, at once ideal and real; it is the concretization of a ritual act to which it gives a structure, a meaning valid not only for the officiant on duty, but also for those benefiting from the ceremony, whether single individuals or a group. Before taking on that form, music has crossed history, countries, people: it has turned into a cultural act, not merely a destination, but another boundary line, similar to the ones previously described, which contains in itself all potential changes. We are confronted with another kind of journey, along which every disperceptive sign can reach other levels of perception, reception, and meaning; and gestures, bodies, signs and notes are likely to show themselves spontaneously. This small “picture at an exhibition” (after the title of one of Mussorgsky‟s compositions) allows me to introduce a particular and complex therapeutic-musical phenomenon which I have mentioned. This is tarantism,83 which was much widespread in Salento (south-eastern area of the Puglia region) in the Sixties. Thoroughly described by de Martino, today it exists no longer, at least in that guise. During my meetings with Michele Risso (an inspiration source for my degree dissertation), who regarded the remarkable religion historian as the first Italian transcultural psychiatrist (Ancora 1997, pp. 94-97), he showed to me that, within a “scheduling of needs”, also malaise is to be connected to an identity process. As argued by Chiriatti,84 the current phenomenon of neo-tarantism is rather linked to the desire for identification with the “culture of well-being”, even though it has not lost traditional musical elements (singing, dancing, such as the pizzica, etc.), as its most typical forms of expression. In one of my journeys to Salento, I have had the opportunity to meet Gigi Stifani, who can be 82

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Among others, see: Lapassade, G. (1976). Essai sur la transe. Paris: Éditions Universitaires; Edelstein, M. G. (1981). Trauma, Trance and Transformation. A Clinical Guide to Hypnotherapy. New York: Brunner; Mazel; Akstein, D. (1992). Un voyage à travers la transe. La Terpsichore – Transe – Thérapie. Paris: Éditions Sand; Leiris, M. (1958). La possession et ses aspects théâtraux chez les Ethiopiens de Gondar. Paris: Plon; Carpitella, D. (1983). Etnomusicologia. In DEUMM, Il lessico. Vol. II. Turin: UTET. See: de Martino 1999. On musical issues, see also: Carpitella, D. (1961). L'esorcismo coreutico-musicale del tarantismo. In de Martino, E. La terra del rimorso. Milan: Il Saggiatore, pp. 335-372; Rouget, G. (1985). Music and Trance: A Theory of the Relations Between Music and Possession. Chicago, IL: University of Chicago Press (originally published as: (1980). La Musique et la trance. Paris: Gallimard); Ferrari De Nigris, D. (ed.) (1997). Musica, rito ed aspetti terapeutici nella cultura mediterranea. Genua: Erga Edizioni; Ferrari De Nigris, D. (1994). Il ciclo della tarantata. Ed. Canto antico della nostra terra. Brindisi: Edizioni Ctg. On the historical origins of tarantism, see a study carried out by Giorgio Baglivi in 1695 (Baglivi, G. (1999). De tarantula. Ed. M. Merico. Calimera (Lecce): Edizioni Aramirè) and a work by Francesco De Raho (De Raho, F. (1994; first printed: 1908). Il tarantolismo nella superstizione e nella scienza. Rome: Sensibili alle foglie). As far as research in ethnomusicology is concerned, Luigi Chiriatti is the foremost expert in Salento. All his works deal with the identity path that such a beautiful land has finally been able to restart without any awe or intellectual redemption.

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considered as a historical figure, a natural connection, a veritable trait d’union between these two cultures (well-being/malaise). De Martino was the first to meet him, followed by Diego Carpitella, founder of ethnomusicology in Italy, Georges Lapassade85 (during his research on trance), and, finally, researcher Luigi Chiriatti, who was lucky enough to have him as advisor in his research on and revival of Salento's musical traditions. Today the meaning of dance is one of reconquest, rather than remorse, along a different identity path. The sight of so many young people dancing in squares and reaching a veritable state of trance (as we know, absolutely commonplace86 in normal conditions in other cultures) shows that traditions are maintained and, most importantly, a specific culture is being relaunched, a culture which I am glad to belong to today more than ever. Now I shall describe my interview to Gigi Stifani, the tarantula healer.

The Tarantula Healer Obviously the transcription of this interview cannot convey the brilliancy, the fascination, the “nearly palpitating” words, and the sound of the musical tales of this extraordinary figure. I meet him in Nardò, near Lecce, (in Salento, the south-eastern area of the Puglia region), in those very premises where he worked as barber for many years. This “healer” is a nonordinary, lively, healthy and clear-minded 85-year-old man who has listened to and lived through, in long periods of his life, stories of tarantati87 and people suffering from other diseases. His records, which cannot be accessed (“professional secrecy”, he says), contain notes taken during the treatment, at the onset of the symptomatology, on the results obtained and the musical therapy applied, and so on. In his interventions he has always followed the traditional approach: diagnosis, prognosis and therapy. He says: “Also de Martino used to ask me: „Master, what are the signs showing that a person is tarantata and that a treatment can be started?‟ „It‟s a secret,‟ I would answer, „every man to his craft‟.” He continues: „I was a workman. I earned 4 liras a week. We were in the Thirties and one day a 6-month-old child was brought to me. What could that infant know of life? His parents worked in a tobacco field. In the morning they had left their child in a basket and when they had gone back to get him, he had not awakened. They thought he was sleeping. But he was not. A gig was passing by and they took him to the doctor who didn‟t know what to do. Then they brought him to me, right here, into this barber‟s shop, where I started to “caress” the strings of my mandolin looking for the right notes. When I found them, the infant woke up and smiled. Today he is old and has children and grand-children. And still, every year, on 29 June he travels to Galatina! My work has always been very tiring, and yet very rewarding. I remember there was a time when I couldn‟t find the right tune and a person who had been bitten by a tarantula danced for 28 days in a row. How tiring! Working and 85

Georges Lapassade particularly insists on the Latin root of the term “trance”, that is the verb transire, originally indicating the passage between our world and the world beyond. See: Lapassade, G. (1987). Les états modifiés de la conscience. Paris: PUF. 86 Referring to his experience in Bali, Milton H. Erickson ensured that seeing a woman in trance at the marketplace was common. See: Rosen, S. (ed.) (1982). My Voice Will Go With You: The Teaching Stories of Milton H. Erickson. New York: W. W. Norton and Company. 87 Tarantati: persons affected by tarantism, that is, bitten by a tarantula and possessed by the spider‟s poison [TN]. In Galatina, on 29 June, the day dedicated to Saint Peter and Saint Paul, dances are no longer held: the traditional ritual which I had the chance to witness in the Seventies has died out. However, since then, other forms of celebration have emerged. Expressions of devotion have changed and follow a different ritual (in Paris, in 1983, during one of my meetings with Carlo Severi, he mentioned the term “para-rite”).

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playing with a taranta is very difficult. One has to play with him/her and participate in his/her suffering. That there were only women is not true. There were also men. Actually, the sight of a completely transformed man is frightful! What I do, once I have understood the nature of the disease, is sending a helping message to the diseased to make them understand that I am playing on behalf of Saint Paul, that I am his intermediary. It‟s not me that heals, it is Saint Paul: I only act in his name. If a taranta is deaf88 and cold, he/she needs to be warmed and this is tough work. I do hope there will be no more tarantati. My health is not strong as it used to be. This work requires a lot of energy. However, today, when so many drugs are being disposed of in the country, tarante have disappeared, they are no longer to be seen. They have been poisoned before they can poison in their turn. I remember when I was a machine-gunner in the war and I was on a Greek island. They brought me a Greek man, of a different religion from mine, who, all of a sudden, had become silent and weird. No one understood what had happened to him. The military doctor gave him some drugs, but to no avail. When I saw him I realized what the problem was. I started playing and, although being a Greek Orthodox, he understood my message and recovered. He thanked me, but I told him that it was Saint Paul the one to thank. I don‟t know whether this saint is also recognized in the Greek Orthodox church. You see, you are a doctor. But I have not always gotten along with doctors. I‟ll tell you a tale. Some time ago I was sent for to see a woman who had been touched by the “poison”. As soon as her GP saw me arriving with my fellow musicians – actually, I had already seen her and understood what her problem was – he got furious. When I started playing my fiddle he interrupted me and threatened to call the police to have me arrested, should I continue playing. Yet, we continued and played for three hours, that is, until results were evident. The GP apologized and asked me what I had played and what I had understood. I told him nothing.” Turning to me, he adds: “You see, you are a doctor and a psychologist. You told me that you heal through words. As to me, I heal through music. I guess you understand what kind of treatment the diseased needs. The same applies to me. It‟s not the same music for all. When I play, I also do it to understand the state of suffering. Once I realized that the person I was to heal had not been bitten by a tarantula, but by a dog. I understood this from the stare; the person‟s eyes seemed falling out of their sockets. I haven‟t always played pizzica, but also funeral marches by Chopin, arias and opera pieces, The Barber of Seville by Rossini, La Traviata by Verdi. In this way, I could understand the kind of suffering I was to treat. If the diseased did not like the music I played and was a tarantolato, he would not dance. Often, after trying many pieces, with much effort, I was asked: “Why haven‟t you played this earlier?” No offence meant, when I talked with Professor de Martino and Carpitella, I told them that science couldn‟t explain this kind of things. In these cases, if drugs are prescribed, the person is harmed. The healer has to have faith and, I mean, not only in the healing power of music. Once, on a boat, I had a vision: Saint Anthony appeared to me. He was the one to guide me. At the time I was just a machine-gunner.” We interrupt the interview because he wants to show me the instruments he jealously keeps in the back of his shop. “How many instruments can you play, master?” “You mean the stringed ones? All of them!” “Now, what about your condition?” “Now, I play only for my own pleasure. I suffer no longer and I see no more suffering. Once in a while I travel to Galatina…” He does not mention his old age. “Bye bye. You can always find me here.” 88

This term lies half-way between tarantula and tarantato, to indicate a non-border, a personification of the spider.

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At this point, it is useful to report a few observations89 I made “on the way back” from this journey across our own culture. The transition from malaise to well-being, described at the beginning, is a characteristic that makes master Stifani another border man, a bridge between two cultures, the one of suffering and the one of the resumption of traditions on the part of new generations. The music that has remained represents a track-baton, the witness connecting different times and ages and ensuring continuity. Stifani is also a go-between man, who acts as an intermediary, just as shamans do with the world of spirits. It‟s not him the one who heals; he does bring the work to an end, but, of the whole process, he only accomplishes the final part. He is also a doctor, an expert who recovers pieces of a story suddenly interrupted by the disease and makes a diagnosis – thus distinguishing the different states of suffering – by verifying the most adequate musical medicine and establishing through his own sensations the duration of a treatment which involves him personally, because he suffers side by side with the one who has asked him for help. Music has a liberating power. It is a sort of infecting cultural “poison” whose incredible power can drive away and destroy other poisons, and, especially, can touch, or rather “pinch” [TN: in Italian pizzicare, a verb which has the same root as pizzica, a typical dance]. “Whenever I play,” the master says to me, “I start a journey together with my tune and, when I feel a channel that can open up, I perceive the story of the person before me.” Actually, he still plays because he uses his own music to heal himself, as every good physician does. Entering his world is very difficult especially because it is less remote than the ones previously described and, consequently, one has the impression of something more accessible. Stifani owns a universe made of “other” notions, like those of “other” worlds, and is aware of possessing a healing power, a power able to solve a crisis. Can a shaman be possibly asked what his care method is? Can one ask a traditional healer the same question? His secrecy about names, treatments and ills implies a great respect for those who have turned to him for help. In modern terms, should I be carried away by the desire to express everything by means of theoretical concepts, I would define him as a “builder of realities”. Describing his way to participate in stories, to establish a connection with impossible worlds, and to create music codes which break off with everything is a hard task. Just as the drum to the shaman, to him the fiddle is not merely an instrument, a device, or a background, but a doorway, a unique path that others cannot tread. Just as happens with the master of ecstasy, the fiddle is a source of energy that transforms him and connects him to everything that previously was unapproachable. In this light, well-being is not to be considered as a condition characterized by the absence of malaise, but, rather, as a declaration of intent, a positive state, a condition where one feels better (indeed, the desire to feel better), a desire for change. What has been described so far can help to better understand the framework where tarantism manifested itself in the past and draw a comparison with the present, completely different also as regards the rite – which has definitely died out in the classic forms of expression described by de Martino. Actually, although in different terms, the desire for liberation remains – through a non-remedial approach, that is, one based on a different planning, on “horizons of care” which consider musical culture as a resource and not merely as a state of suffering. That is why trance, which that particular kind of music can induce, 89

They are also the result of long conversations with Luigi Chiriatti in Calimera (near Lecce) and after concerts of music bands in villages in Salentinian Greece (where Griko is spoken, a language resulting from the merging of ancient Greek and “salentino”).

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once again acquires the features typical of normality, not of suffering. In other words, music becomes a fundamental step – history, research, reinterpretation of one‟s traditions based on a different attitude, one‟s land – that finally seems reluctant to get mixed up with other forms of musical expression (tamburiata, tarantella, techno trance). Indeed, these “monumental defences” hide the need for more oxygen, some new and fresh air, that is, the need to recover the atmosphere of one‟s home, so far represented through myths and whose freshness has been lost. Obviously, the next step is exposing this music to the contact with others, through a contaminating process – at once passive and active – which aims, at once, to recognize and be recognized. Tarantism, thus, shall be no longer viewed as re-morse, but as re-covery, ecstasy (in the sense of “getting out”), the land of re-cognition, and the beginning of a path leading to the gaining of a different identity and dignity as an individual. The desire arises to get out of the shadows, expose ourselves, by expressing “our belonging to the world”, on the one hand bound to tradition, on the other striving for new and more visible routes. This need/desire – which for long has been hiding itself in the bends of the fears created by suffering – can finally burst out “in the open” as a purifying catharsis, built up in so many 29 June. It is perhaps for this reason that the desire is widespread for music, songs, dances, and forms of expression, which are similar to the past ones, but are different “inside”: the projection of a more evident, open and compact cultural self, with no disintegrations or repressions. Dance, as Chiriatti remarks (1995), is “[…] liberating, […] the pizzica is a good alternative to disco music; it is closer to our cultural traditions, our sense of identity, and the way we feel music […]!”

2.3. A JOURNEY INTO THE WORLD OF PSYCHOSIS So far we have seen that we can make so many different journeys, not only to know other countries, but also ourselves: journeys inside and outside ourselves, journeys into other worlds and other methods of treatment – such as those showed by shamans and traditional healers –, and journeys “into the others” who often end up being different from what we fancy. The encounter has to encompass, by nature, dialectical elements, a “bidirectional” potential, and the reciprocity of the “event”, as meant by Weber,90 according to whom “only those who can be amazed by the chain of events can question themselves about the meaning of the universe”, and Stengers (1987) who believes that an event is “the simultaneously logical and improbable product of an encounter”. The journey of a family therapist or a mental health worker is always that of a researcher/ethnologist, as already noted, that is, an initiator, ready to initiate and be initiated, with the ambivalence implied by these terms. He is very alert so as to grasp any temporal/spatial and cultural suspension and, at the same time, is willing to know about new calendars and clocks that generate confusion and new centres of gravity. He is similar to a traveller who wanders looking for himself in different places and among different people and, when he buys some new food, he is ready to mix it in the same bowl that contains the one he 90

Cited in Morin, E. (1972). Le retour de l‟événement. In Communications (No. 18, pp. 6-20). The French author, a great challenger of established ideas, argues that an event introduced into the completed logic of structures makes them explode, swell, and change. This is a sort of “outrageous residue” which defies those who believe that science is meant to address only general issues.

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already has (Aveni 1989).91 Is this a praise of blandness,92 that is, something whose definition is always in progress? It certainly is if by “defined” or “completed” we mean the finishing line, the target, something that has been achieved by missing adjustments and enriching elements such as those created by a thought in transition and able to move across. Those workers who, instead, are confronted with dramatic situations that also imply a “high risk of alteration” necessarily feel in itinere and, consequently, need even more the nomadic approach which I have repeatedly made reference to, the only one that allows to get closer – through interstices and fords – to the banks of inaccessible pathologies. A step forward is represented by the awareness to be or feel oneself “in transit”: between two countries, between a place and a non-place, between a pharmacological and a traditional treatment, between worlds inside and outside oneself. Though it is true that the journey contains transformative and dialogic parts, still, through their anthropological research, many authors (in particular, Turner and Eliade) have found in the journey a ground of metaphors with a global origin, a garden of symbols by which transitions and transformations of all kinds express themselves (Leed 1992).93 There exists, however, another kind of “crossing” and it is on this that I shall dwell longer in this chapter: I am referring to suffering, sharing, participating in moments, phases, or steps together with someone who, instead, wishes to travel on his own, with no fellow travellers. Thus, the question is: in order to set out on such a journey, are we willing – even though temporarily – to “suspend” our world views, the way we look at reality, and our beliefs? Are we ready to take apart categories and diagnostic needs and attempt to enter the inaccessible and distressing psychotic world? Actually Searles (1986)94 describes the journey into the hell of the psychotic, that is, all the opportunities/skills that are to be used to build the bridges necessary to reach what is not visible, and whose gravity is yet evident, risking to dis-arrange and dis-mantle oneself and coming into contact with apparently distant, broken and inaccessible worlds. Is there the willingness to cover that distance and buy the ticket to get into a world where intentions and sensations are as important as techniques and paradigms? Resnik95 adds – out of love for reality and loyalty towards oneself and patients alike – that the ticket must always be a return ticket. By means of these references I am attempting to describe what cannot be described, that is, express in writing emotions and representations 91

Aveni, A. (2000; first printed: 1990). Empires of Time: Calendars, Clocks, and Cultures. London: I. B. Tauris and Co. On the character who “wanders, crosses streams and ponds, falls…” see Canto notturno di un pastore errante dell’Asia (Night Song of a Nomadic Shepherd in Asia) by Giacomo Leopardi, a poem written between 1829 and 1830 and included in Canti. For an English translation of this poem see: Leopardi: Selected Poems. Trans. E. Grennan (Princeton, NJ: Princeton University Press, 1997). 92 See: Jullien, F. (2007). In Praise of Blandness: Proceeding from Chinese Thought and Aesthetic. Trans. P. M. Varsano. Cambridge, MA: MIT Press. (Originally published as: (1991). Éloge de la fadeur. Paris: Grasset.) 93 In his fascinating work titled The Mind of the Traveller (New York: Basic Books, 1992), E. J. Leed wonders how a simple transition can influence individuals, shape social groups and change the permanent structures of meaning that we call “culture”. I viaggi della storia, by VV.AA. (Bari: Dedalo, 1988), is about other journeys which have marked history (from the pilgrimage to Saint James of Compostela to the Silk Road across Europe and Asia). Meetings with Remarkable Men (New York: E. P. Dutton and Co. Inc., 1963), the most renowned work by G. I. Gurdjieff, an enigmatic traveller as well as a musician and a singer of pieces of wisdom from central Asia, lies at a different level, one that is more experimental and ecstatic and describes journeys aimed to disclose hidden knowledge. Finally, Sandra Puccini refers to the journey as initiation in Andare lontano. Viaggi ed etnografia nel secondo Ottocento (Rome: Carocci, 1999). 94 Searles, H. F. (1986; first printed: 1965). Collected Papers on Schizophrenia and Related Subjects. London: Karnac Books. 95 Resnik, S. (1987). Lo spazio mentale nella psicosi. In Proceedings of a Seminar at the Centro studi di psicoterapia e ricerca sistemica (Rome, 6 June 1987, personal paper).

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from a particular world and a particular journey: that of our diseased and their/our suffering and distress, that of the encounter that we succeed/fail to create. Describing one‟s clinical experiences in a way that encourages others to reflect is difficult. Actually, there are times when in my daily work I feel disoriented. This happens, in particular, when I witness moments and situations where order and disorder, organization and chaos reign. Actually, feelings such as distress, bewilderment, and fragmentation often remind of the fragile boundaries that separate one‟s frame of mind from that of the diseased who have lost the organizational grid necessary to protect themselves from the disperceptions they feel they are dominated by. This is the account of a difficult journey accompanied by some elements which appear to clash with one another and yet often co-exist in psychosis: distress and ecstasy that relate to each other, in that particular process that is therapy. Distress is to be interpreted as agony, a melting pot of feelings of suffering that swarm in the workerpatient relationship, which is always poised, secured only to a very thin thread. Ecstasy is to be viewed as a borderland, a limes between normality and insanity, as well as relinquishment, dedication, “climax”, elevation from the ground, and going out and coming back. Psychosis is the ground of non-change, unattainableness, and risk. In this regard, Bateson (2000) maintained that to the therapist and the researcher alike the main problem was “performance”, which, as witnessed in our daily activities, is put under great strain in the relationship with the most seriously ill patients. Working with families is not only a self-evident official duty to be observed, but also the satisfaction of a more or less explicit need (sometimes expressed just inside): asking for help from all family members in order to tackle a problem – as serious as psychosis – that blocks the whole system. Assessing all available resources (skills and performance of the therapist included) is like verifying the willingness of fellow travellers to face the countless levels of distress, both theirs and the others‟. Distress connotes a world which involves us and yet, perhaps, fascinates us, enabling us to measure ourselves against a condition of serious psychic suffering and refrain from declaring our defeat right at the start. The whirl of sensations that this process triggers is most varied and conflicting: agony/ecstasy, attraction/repulsion, humility/omnipotence, going to/coming back, setting boundaries/crossing boundaries. In a way, these experiences can allow approaching the areas lying close to the sacred, an aspect inherent in any medical activity, where enthusiasm, sacrifice and transformation co-exist, just as colours that are at once bright and dull. How often have we felt like Icarus, confident to have reached the sun and found the “explanation” for a certain psychic suffering, only to crash onto the hard ground of psychosis soon after? Often, as soon as we believe to have finally attained a solution, through the latest pharmacological formulas or the most sophisticated psychotherapeutic techniques, a sudden crisis reminds us of the frailty and the modesty of our means. Our relationship with psychosis teaches us that every element “explained” by means of the decoding tool used has often resulted being only one step of a long and very complex process. In order to access this world and, at least, breathe its air, it is necessary to “bet on oneself”, which does not mean betting on something or someone, but questioning oneself, “disarranging” oneself – both literally and metaphorico-therapeutically – to be able to recompose oneself on new foundations of empathy and knowledge. This is the kind of journey described earlier on and meant by Searles, who, having dealt with these patients and made contact with all their components for a long time, might have gotten “infected” himself. If we, as therapists, succeed in viewing schizophrenia also as a defence that the patient uses to compress pain, love, hate, jealousy, and other “negative” feelings, we might be able to understand why the patient holds onto his

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disorder so tenaciously. Psychosis – that we are often unable to tackle, because we can‟t even get into touch with it – is a universe of perceptions that the patient has built in years. It is the outcome of his best judging abilities, and deserves dignity and respect; carried away by anxiety or the umpteenth frustration, we cannot simply ask him to relinquish it and accept our personal world view. Once again, the need to explain what travelling with the patient means is urgent. Undoubtedly the journey is an act of solidarity on the part of the one who proposes himself as a fellow traveller, ready to share food and hardships, as well as his sensations about the world, exactly as he perceives them inside, and not as he may passively feel and accept them on the surface. Accompanying, participating, and (co)-creating new and different realities can represent a prop to hold onto on the way back, just as shamans96 do during their journeys. Only a therapist-ferryman can make bridges work again, even though with some efforts, at first in agony, and then in ecstasy, as Whitaker would have it.97 Clinical experiences teach us that the dangerous terrain of disorder and disorganization necessarily implies that we question our own cognitive grids by actually “going outside ourselves” and thus reaching new shores (of knowledge), where parts of us – hidden or timidly kept hidden – can be finally disclosed. I am referring in particular to “creative power”, “delirious intuition”, “paradoxical provocation”, “asymmetry” (these concepts shall be further explained later on) and all those elements necessary to interpret the forest of symbols that often traps, just like thick Amazon lianas, our attitude (by which we are influenced to such an extent that we often end up talking about diseases rather than patients). During a conference in Italy, Prince reported that “the psychotic experience” is similar to a death-and-rebirth experience which, in a way, is like a shamanic call in that it leads to the emergence of a stronger and more flexible Self after the breaking of the rigid Self98. It is generally known that transpositions across different contexts – in this case, Siberian shamans‟ experiences – can be very difficult as well as dangerous. However, 96

Cf: Eliade, M. (1972). Shamanism: Archaic Techniques of Ecstasy. Trans. W. R. Trask. Princeton, NJ: Princeton University Press (originally published as: Le chamanisme et les techniques archaïques de l'extase, Paris: Payot, 1951). I also suggest reading the acts of the conference held in 1996, in Italy, on the prominent religion historian‟s thought which were collected and published as: Arcella, L., Pisi, P., and Scagno, R. (eds.) (1998). Confronto con M. Eliade, archetipi mitici e identità storica. Milan: Jaka Book. In all his works Eliade argues that the crises that modern man goes through are mostly religious, so long as they result from the awareness of a “lack of meaning”. Who else can be rightly considered as a forerunner of these passages but the shaman – even if only in a specific cultural, social and religious context? To make their journey, shamans supposedly “leave behind their bodies”: this kind of experience, described as an ecstasy, is a process at the heart of which shamans literally “go out of themselves” (according to the literal meaning of the Greek word ekstasis = being outside). These mediators between worlds actually connect and reassemble apparently disarranged parts of the same world. Through the different steps of a shamanic session or kamlania (kam is what Turks of southern Siberia called a shaman) the state of trance known as “shamanic ecstasy” is reached. As I could observe in my personal (though limited) experiences in Mongolia and Siberia, this is achieved without the help of any substance, except vodka, which actually accompanies any activity, ritual or not, of daily life down there. The journey that leads the shaman into a parallel world is, actually, a means for the person asking for help to reconnect himself to the part of his world that, in his condition of suffering, he perceives as distant, detached. Villa (1988) accurately points out that: “the shaman is not simply a „technician of ecstasy‟, but a cultural operator whose transformative action impacts on the „border zones‟ of the culture where he stands allowing individuals and the community to which he belongs to renew the feeling of and the reasons for their personal, social, historical and religious identity…” 97 Whitaker, C. A. (1989). Midnight Musings of a Family Therapist. New York: W. W. Norton and Company. He claims that one of the healthiest components of psychotherapy is the capacity to transcend the relationship of affection that has been established and observe with warmth and sympathy also ironical aspects, disorientation and disorders. 98 Prince, R. (1997). Conference at the Servizio Speciale di Psichiatria e Psicoterapia, La Sapienza University (Rome, March 1997).

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this “internal legitimation” is useful to look at shamans as ancestral sources, individuals that defy inaccessible places and spaces. Actually, my previous considerations on ecstasy aimed to point out the sacredness of the therapeutic activity that workers, often without their own knowing, would enact in the past, whereas today it seems as if this dimension no longer belonged to us. And yet, it has always been a fundamental part of therapeia. Ecstasy, therefore, is to be meant as getting out and attaining joy and awareness, after surviving the storms and the dangerous reefs generated by the therapeutic process. It then happens that dismantled and disorderly parts and scattered pieces come together again, and, at least for one brief moment, they can hope again for reunification, harmony and pacification. Today, this “sacred” process is seemingly in conflict with molecules and chemical products that, in hope or resignation, are being invoked – in the most complex cases – as veritable lifebuoys! Ecstasy means a step or the final destination, a temporal and spatial suspension which has been yearned for so many times as the means to enter other dimensions of a closed world. Ecstasy means breathing, a rest and a reassuring pause, the enjoyment of a meditation wine, happiness in the look of someone who can finally recover the use of his facial muscles, which regain their true expressions and give a faint smile, though still timidly and precariously. Ecstasy means returning to a new, apparently forgotten, energy that allows to rediscover grounds which seemed inaccessible. Ecstasy means disclosing those new elements that, just as a frail bridge made of boats, can enable us to reach the opposite bank. Finally, ecstasy means love, which represents an ancestral medicine not yet belonging to official pharmacopoeia, that sometimes succeeds in lighting the dark and obscure parts which have always covered and hidden it. In the difficult attempt to define in a few words the journey with the psychotic, I suggest considering it as a “typical” journey into the world of the other one, with the fear to lose oneself and fall apart. It is also a leap into another dimension that often appears to be a nondimension, where there exist no parameters and other languages and forms of expressions are employed, often inaccessible. Therefore, access codes are needed that are similar to the ones necessary to enter different worlds and “other” worlds with their own culture and their own systems of beliefs, but always walking on tiptoe, ready to get off the “cart” of certainties and ride a “wild horse”. Along this path, if the wish is to attempt a contact, “falls” and the risk to be unseated are to be taken into account. Although being used to other languages, different realities (which he makes contact with), and “primitive” lexicons and syntaxes, the anthropologist-therapist, who is normally able to employ correctly what he observes, can come to a standstill when he is confronted with the meta-languages simultaneously used by the psychotic, through equivocal communication frames. If the aim is to go closer, one has to start moving “mentally”, just as in a ritual or a ceremony of a particular culture, whether near or distant. The psychotic typically looks for symmetry because it is reassuring99 and easier to integrate into his logic, which, though confused or wrong, is nevertheless always “coherent”. In this regard, Lévi-Strauss (1961) argues that individual manifestations of delirium obey to the same formal processes of collective myths or institutionalizations of ritual gestures in both sacred and profane ceremonies. The diseased is often an individual who finds it difficult to socialize, to relate to others, who lives in a world where the relationship between objective 99

In Le rêve, la transe et la folie (Paris: Éditions du Seuil, 2003), Roger Bastide argues that “we remember that symmetry is comforting when we remember that all the child's socialization processes consist in establishing a symmetric relationship between objective reality and subjective reality, through „the generalized other‟ or the interiorization of the structures of the external and social world.”

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reality, determined by social rules, and his subjective reality is asymmetric. The encounter between the therapist-builder and the patient is, at first, “de-structured” and “de-constructed” so as to allow, later on, a recontextualization of the relationship with new foundations and new access modes. In order to move from a story of “non-sense” to one of “another sense”, the therapist will have to employ all available parts, the asymmetric ones included, of his way of building a relationship (as previously described). The real ground where another reality (or rather another context, resulting from the encounter of two different and distant cultural worlds) can be built, is in itself asymmetric and, therefore, the diseased has an escape and defence reaction. Experiences with immigrants show that, in the country of destination, they endeavour to build a space modelled after the one they were familiar with, precisely because that one made them feel safe and the new environment is still felt as hostile. What happens inside the psychotic is on another level of experience: they always look for “spaces” to restore because the one they live in is home to distress and phantoms. They feel reassured by the symmetrically repeated structures of such spaces, made of closed and fixed patterns inaccessible to change. It is in a such an environment that they conceive their world, a different world, the “other” world to whoever wants to know and explore it and is, thus, willing to cross a weird, different and remote land… The “asymmetric” aspect of the relationship-building process can also make workers feel panicky because they are driven to expose parts of their selves, since they come from another order and level… And yet this very process can be the laying of the foundation stone, so that a new house can be redesigned together or walls can be repainted because the colours, that we believed still bright, have actually faded long since. So far I have discussed about the spatial dimension because it is the most tangible aspect, and, as such, shows the fundamental role played, within a therapeutic process (and within a transcultural one), by the ability to create new and common meeting spaces, for the patient, the physician, the family, the nomad, and the permanent resident. The building of the culture of meeting encompasses, at least, two major steps: 1) the mobilization of all external and internal resources made available, by degrees, by the reality being built, which implies giving even the smallest detail the opportunity for “landing at the airport of destination” (Terranova Cecchini and Tognetti Bordogna 1992) and 2) a journey “in the other world” where both other and world require, first of all, that the traveller/therapist carry in his bag the curiosity typical of an anthropologist and the flexibility, so often called for in these pages, necessary to suspend his bearings and adapt himself to “new latitudes”: a medical service, a hospital, a welcoming centre, a therapeutic community, a camp, or a caravan. Such a meeting place, both real and ideal, is a space of knowledge, a tool for mutual experiences, a bet that we hope to win, a different attitude (these issues shall be thoroughly discussed when clinical practice is described).

Chapter 3

CULTURAL PROCESSES AND MIGRATORY PROCESSES 3.1. THE STRANGER AMONG US “What am I doing here?” wonders a very special migrant such as Bruce Chatwin, “someone who is always on the go” (1989). It seems that this question is common to many, among us, who, in these uncertain times, are slightly bewildered, always in search for their identity and a definition of themselves, especially in the interstitial and peripheral areas which have not yet been reached by the anonymous logic underpinning modern society. Anthropologist Lévi-Strauss raises the following question about the investigator's goal: “Why did he come to such a place?”100 in Tristes Tropiques, one of his liveliest and most detailed diaries on his “philosophical journeys”. Soon after, he wonders: “What is, in point of fact, an anthropological investigation? Is it the exercise of a profession like any other, differentiated only by the fact that home and office-laboratory are several thousand miles apart? Or does it follow upon some more radical decision one that calls in question the system within which one was born and has come to manhood?”101 And he continues: “If the West has produced anthropologists, it is because it was so tormented by remorse that it had to compare its own image with that of other societies, in the hope that they would either display the same shortcomings or help the West to explain how these defects could have come into being.”102 This is why “the other”103 has often been constructed as a subject to study (especially emphasizing differences and distances), classify, or, at best, describe with some “strange and bizarre” details. For a long time, building a relationship with “the other” was not compatible with an objectifying scientific thought and a leading culture that simply aimed (and still does?) to answer the question “Mirror, mirror on the wall, who in the land is fairest of all?” Perhaps it is also for this reason that ideas such as racism and ethnocentrism have become 100

Lévi-Strauss, C. (1961). Tristes Tropiques. Trans. J. Russell. New York: Criterion Books. (Part IX. The Return – Chap. XXXVII – The Apotheosis of Augustus, p. 374) (Originally published as (1955). Tristes tropiques. Paris: Librairie Plon.) 101 See note 105. 102 Lévi-Strauss, C. (1961). Tristes Tropiques. Trans. J. Russell. New York: Criterion Books. (Part IX. The Return – Chap. XXXVIII – A Little Glass of Rum, p. 388) (Originally published as (1955). Tristes tropiques. Paris: Librairie Plon.) [Emphasis in original] 103 In his lively and meaningful essay titled L’invention de l’autre. Essais sur le discours anthropologique. (Lausanne: Payot, 1994), anthropologist Mondher Kilani completely reviews this concept, by deconstructing aspects and logics that have contributed, for a long time, in the West, to “invent the other”, always viewed as a subject of investigation and representation on the part of a given leading culture. According to Kilani such a culture demands that such descriptions and definitions become universal and valid for all.

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rooted so deeply that by now they are common to very different political ideologies, with different nuances. In a novel-essay titled The Golden Droplet, Michel Tournier104 wonderfully describes this attitude through Achour's words. The character remarks that it is not true that the French cannot stand the Arabs: in their own way they like them, but only so long as they know their place. The Arabs have to be humble, miserable. A rich and powerful Arab, the French can‟t stand that. They are sympathetic with poor Arabs, especially the left-oriented French. And feeling sympathetic gives them so much pleasure!.. At the time of the French domination in Algeria, there existed a leading scientific thought which influenced all disciplines. One need only think of Frantz Fanon who, apart from playing a fundamental role in the liberation of Algeria, was a prominent neuropsychiatrist and neurosurgeon known for having demolished all the theses supported by the Algiers psychiatric school run by Porot.105 The question on whether they are viewed as “developed” beings is the one that the exiled, the wrecked, migrants and nomads also ask themselves – although on a different level – when they realize that the minimum conditions of their existence are increasingly at risk. In his famous novel titled The Outsider (or The Stranger)106 Camus describes the existential problems of an employee who lives in Algiers, in such a state of neglect and indifference that he feels as a “stranger” to himself first and to the world after, to the point of doing nothing to defend himself when he is sentenced to death. The need to hold onto something familiar, some friendly support, some “mental oasis”, even if only for an instant, is ever-present in us, and we feel it especially when we perceive the surrounding environment as unknown or, indeed, hostile. Ginzburg (2000) points out that the fact that it‟s the same the whole world over does not mean that all is the same: it simply means that we are all ill at ease with something and someone. But in a world such as the one that is taking shape, what does stranger mean? In a way, the message conveyed is paradoxical. On the one hand, the world is expected to become standardized and homogeneous, where a place for strangers is possible, since everyone can “theoretically” get to know all possible worlds; on the other, there emerge life conditions based on self-sufficiency or unrestrained individualism (this theme is dealt with by Paul Zweig in his beautiful The Heresy of Self-Love: A Study of Subversive Individualism, 1960). In such a context, feeling as a stranger to oneself as well as to others is very likely. Never before has the theme of the stranger been so topical as today, when migration flows exhibit much strength and so many differences in face features, clothes and colours (by visiting the mosque on Friday morning or wandering about the Esquiline area in Rome or the San Salvario district in Turin it is easy to get a picture of this world in motion). But how is the stranger actually “thought about”? He is often considered as someone 104

Tournier, M. (1987). The Golden Droplet. Trans. B. Wright. Garden City, NY: Doubleday. (Originally published as: (1985). La goutte d’or. Paris: Gallimard.) 105 Fanon, F. (2004; first printed: 1963). The Wretched of the Earth. Trans. R. Philcox. New York: Grove Press. (Originally published as: (1961). Les damnés de la terre. Paris: François Maspéro.) 106 Camus, A. (2000). The Outsider. Trans. J. Laredo. Harmondsworth: Penguin Books (originally published as: (1942). L'étranger. Paris: Gallimard). This work has always aroused much enthusiasm as well as strong criticism. Concerning the latter, in his Critique dans un souterrain (Paris: Grasset, 1976), and precisely, in the chapter titled Pour un nouveau procès de l’Étranger (pp. 137-175), René Girard highlights Camus‟s ambiguity and bad faith. He contends about the author‟s “mystical approach”, according to which Meursault, the main character of the novel, is forcedly depicted as an innocent unfairly persecuted by a society whose extreme wickedness is an undisputable axiom. These issues have also been treated in movies such as The Stranger (1946), directed by and with Orson Welles, which is about the persecution of Jews, and Lo straniero (The Stranger in the English version), shot in 1967 by Italian director Luchino Visconti, drawn on Camus‟s work.

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different, with whom establishing a relationship is not possible and whose cultural remoteness is not regarded as a possible source of knowledge, but as a further barrier which can even lead to an extreme desire for annihilation. That is why today the conditions should be defined according to which whoever is considered as a real stranger and hostile – to the point of being made the target of a veritable war – could be viewed again as “the other”, with whom communicating and building a relationship would be possible, for all the differences from us. In Tristes Tropiques, the work by Lévi-Strauss that I love most (which, in fact, so far I have repeatedly cited), between a “little glass of rum” (obviously from the French Antilles) and a walk in the streets of Martinique, the anthropologist observes that the better our ability to understand the Other, the more his alterity is put into question by the contact with our world (1961). If we attempted to examine the issue within an anthropological framework, we couldn‟t help noting that the origins of this science actually lie in two concepts that have often clashed with each other, have sometimes met, and have for long ignored each other. These two concepts are, in fact, two thought-words: a self and another. They are not simply two terms; they are two complex worlds. On this theme, Bateson (2000, p. 465) gives an accurate description: “Suppose I am a blind man and I use a stick. I go tap, tap, tap. Where do I start? Is my mental system bounded at the handle of the stick? Is it bounded by my skin? Does it start halfway up the stick? Does it start at the tip of the stick?” [Emphasis in original] The questions that the philosopher of nature asks are, as always, many and affect many levels. The stick could be regarded as a thread which allows the blind man to walk as, through it, he receives information on his route, or it could be seen as the area separating him from the rest of the world, and so forth. Actually, the stick is neither included in nor excluded from the nine points (another Batesonian metaphor) which mark the bounds of a given cognitive system. Actually, my previous quotation shows how difficult it is to define where I start/end and where the others start/end. The western culture has always been founded on principles of appropriation, to such an extent that we would like to have the whole universe in our head (!). This desire is actually one of incorporating all that we feel far from us, by standardizing diversity and differences in the name of a single thinking, so as to get rid of that extraneousness and that weirdness that actually fascinate us: in other words, all that is different from us and should be a cornerstone of any multicultural society. As history shows, our society has always felt the need to take in everything: on the one hand, the outsider excites our curiosity; on the other he makes us uneasy. If we fail to “swallow him up”, we reject him and label him for good. Since we belong to a culture made up of many dichotomies and “either/or” statements, it is difficult for the “other” to exist without a label. Never before have we discussed (and, in some cases, have we been forced to discuss) so much about the other and others. In order to deal with today‟s globalization processes and multitudes of immigrants, new investigation tools are necessary, as are new interpretive grids. In this regard, it is impossible to forget the landing of the first large flow of Albanian refugees at Brindisi, in the Puglia region, in March 1991, an event that became a case of “military strategy”, to the point that the then Italian Defence Minister talked about a veritable “invasion that required a military intervention” (!), i.e. guns instead of camp stoves.107 In these cases, what happens is that a defensive approach is taken – psychologically speaking, of course (with no hint to the “military” side of the example above!) – since we are 107

In this regard, a description of my personal experience shall follow (recounted in an article issued in 1991).

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unable to grasp, in a possible dialogue, the differences that can actually enrich the two counterparts. Hence, with the supposed aim of “understanding better”, sometimes we prefer resorting to figures and statistics, conferences and television or radio quarrels! More or less deliberately, we often choose a non-involving behaviour, one of detachment and “political correctness”. On this point, the double defensive mechanism described by Todorov,108 which often traps one's mind, is very interesting. Todorov mentions Columbus who, on the one hand, considered the other as someone similar to himself and absorbed his features only to reject them later; on the other, he regarded the other as someone different and distant from himself and his own ways of thinking and acting and, therefore, he saw him as a decidedly inferior being. What happens is often similar to a siege:109 the self seems to shrink, take refuge in a fortress, ready to defend itself against all possible threats. To keep their balance, our emotions and our way to face whatever is other than us need a “minimal self”, which is not yesterday‟s ruling self, as explained by historian of ideas Christopher Lasch, in his pamphlet The Minimal Self.110 That Columbus left on his journey to discover only America or also the “other” is not known. What is known is that today it is possible to live through an entire life without completing even the first step of the path towards the discovery of the other! The other can be considered in the simplest way, as an object all but merged into the surrounding environment, or, alternatively, in a more engaging way, as an object apart, which is similar to one‟s self, though different. The problem of the stranger has always aroused much interest, already since the times of Georg Simmel,111 who is renowned not only for making the forms of social interaction the specific subject of sociology, but also for being among the first ones to pose the problem of the “internal stranger”, the space inhabited by all cultural and social repressions and where shame lies, in its most insidious manifestation, to re-emerge in a different shape each time, that is the homosexual, the deviant, the Jew, and so on (…the Jew pretends to be like us, but he is among us, he is not like us; or, if he becomes such on the outside, he is inwardly different…). According to Dal Lago (1999),112 “as Simmel puts it, the stranger is not different in absolute terms and recognized as such, from whom a cognitive and cultural distance is kept, but he is the heterogeneous that mingles with the hosts.” Trevi focuses on diversity, or rather, what he defines as the “axis of diversity” (1992).113 More specifically, he makes a distinction between the axis of identity (single elements and components) and the axis of diversity (compounds, aggregates, combinations, and configurations). In his view, the psychologist can catch the individual only at the intersection 108

Todorov, T. (1999; first printed: 1984). The Conquest of America. The Question of the Other. Trans. R. Howard. Norman, OK: University of Oklahoma Press. (Originally published as: (1982). La Conquête de l'Amérique, la question de l'autre. Paris: Éditions du Seuil.) 109 With an extraordinary sensitivity and variety of shades, L’assedio, a beautiful movie shot in 1999 by director Bernardo Bertolucci (the English title is Besieged), tells about the cultural and emotional dynamics of an Italian man and an African woman through the description, not in the least obvious, of a love relationship. Peter del Monte has also focused on these issues in two insightful movies: L’altra donna (The Other Woman), where he analyses the relationship between an Italian woman and her black home servant, and La ballata dei lavavetri (The Ballad of the Windshield Washers), on the problems of a Polish family migrated to Rome. 110 Lasch, C. (1985). The Minimal Self. Psychic Survival in Troubled Times. New York: W. W. Norton and Company. 111 Georg Simmel (1858-1918) was a co-founder (with Max Weber) of the German society for Sociology. Cf: Simmel, G. (1950). The Sociology of Georg Simmel. Compiled and translated by K. H. Wolff. Glencoe, IL: Free Press. 112 Dal Lago, A. (1999). Non-persone. L’esclusione dei migranti in una società globale. Milan: Feltrinelli. 113 In an article published by a notable scientific journal (Sfera, No. 27, May 1992).

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of these axes. However, he shall need to be particularly careful: if he moves even slightly to one side, he shall find himself with the philosopher who is only interested in the “individual”; if he moves to the other side, he shall find himself with the biologist whose only interest consists in DNA and its nucleotides. Therefore, it is necessary to create an interstice, a boundary area where one can tread in full awareness. The threshold which I have discussed about at the beginning of this book – a space that can be either opened or closed – is embodied by the stranger. This figure takes on the appearance of a “frontier spirit” and a social limit, a line where desire and hope lie, as do the wish for acknowledgement and identity and the constant tendency to cross the border, a tendency which barely keeps a Self poised between the “new” – known since a very short time – and the longing for the “old”, bitter but reassuring. The uninterrupted going back and forth between sedentariness and mobility, between lived experiences and mental and emotional maps to trace out again, between dreams to realize and a tough reality to face, is the bumpy terrain which one has to cross. An interactive mechanism governing all these aspects – often lived as clashing with one another – lies at the very heart of this process. It's society itself that needs the stranger: the social system demands and rejects him, in order to keep its identity and provide its internal debates with momentum and dialectical power, as we fear, all the way, to lose our boundaries and find ourselves in the other‟s arms, without knowing whether this contact, at the very end, might bring us any riches. The possibility to consider the self as separate from the other lies in these movements which reach out to the very boundaries of one's being by allowing it to recognize the other as other than itself, and yet the same, precisely because of its being different.114 The process through which we make contact and enter a relationship with otherness is a continuous dialogue (in the sense of “word between”) and a continuous metalogue (in the sense of “word beyond”) aimed to “demystify mentalities” (Lloyd, 1990). The anxiety that such a process may arouse reveals, on deeper levels, what the other can really represent for us. Finding out that we are, as Kristeva asserts (1989), Strangers to Ourselves (a work which describes the fortuitous paths of our unconscious) is easy. Besides, history teaches us that the development of countries, such as Great Britain, France, and the United States, has been possible also thanks to “the others”, whose contribution has often been acknowledged only with effort, as witnessed, since ancient times, by many authors, including William Shakespeare who so vividly depicts his fellow countrymen‟s behaviour in Sir Thomas More:115 “MORE Look, what you do offend you cry upon, That is the peace. Not one of you here present, Had there such fellows lived when you were babes That could have topped the peace as now you would, The peace wherein you have till now grown up Had been ta‟en from you, and the bloody times

114

On this matter, see also: Affergan, F. (1987). Exotisme et altérité. Paris: PUF. The author maintains that anthropology takes origin from a self and another and that otherness is indeed the “riches” of this discipline, precisely due to its capacity to disrupt anthropological representations (as Remotti adds in his foreword to the work). The 5-volume work by Cipolla titled Epistemologia della tolleranza (Milan: Franco Angeli, 1997) is very interesting, particularly with regard to the self-other relation. In a 3,000-page analysis, moving across the worlds of sciences and life, the author searches for otherness, differences, and identity, which he considers as processes always in progress.

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Alfredo Ancora Could have not brought you to the state of men. Alas, poor things, what is it you have got, Although we grant you get the thing you seek? BETTS Marry, the removing of the strangers, which cannot choose but much advantage the poor handicrafts of the city. MORE Grant them removed, and grant that this your noise Hath chid down all the majesty of England. Imagine that you see the wretched strangers, Their babies at their backs, with their poor luggage Plodding to th‟ ports and coasts for transportation And that you sit as kings in your desires, Authority quite silenced by your brawl And you in ruff of your opinions clothed: What had you got? I‟ll tell you. You had taught How insolence and strong hand should prevail, How order should be quelled – and by this pattern Not one of you should live an agéd man, For other ruffians as their fancies wrought With selfsame hand, self reasons, and self right Would shark on you, and men like ravenous fishes Would feed on one another.”

In his 4,525-page Zibaldone (written between 1817 and 1832), a “disorderly bulk of writings of different kind”, Giacomo Leopardi provides the example of a powerful thought, which is perhaps unique, in its kind, in European literature (probably only Paul Valéry has produced a similar quantity of notes, in his Cahiers). Leopardi dwells, incredulous, on strangers: “It can be observed that the French, who are the most modern nation in the world as to customs, still preserve that long-rooted frame of mind that all civilized nations have relinquished: contempt for – or even hate towards – strangers. This is definitely something they can‟t be proud of because it absurdly clashes with the excessive modernity of all their other opinions, habits, etc. It is all the more ridiculous as it was justified among the Greeks because they came into contact with the Romans only at a late stage […] and there was no other people that could equal them. As to the Romans, whose great patriotism is well known, we know that they were always very fair in judgments involving strangers and, actually, never failed to adopt the foreign habits that they considered useful, also when that implied dropping or correcting their own.”116 Concerning this issue I wish to draw once more the attention to Germania, Tacitus‟s topical work that I have already quoted. The renowned Latin historian has the opportunity to observe closely the Germans‟ customs and praises their virtues and qualities, even though, in his time, these peoples were considered as mere “barbarians”. Before Tacitus, both Hippocrates, in his treatise On Airs, Waters, and Places,117 and Herodotus, in his Histories,118 115

Shakespeare, W. (1988). Sir Thomas More, Add. II. D. In The Complete Works, edited collaboratively under the General Editorship of S. Wells and G. Taylor. New York: Oxford University Press. 116 Leopardi, G. (1969). Tutte le opere. Vol. II. Ed. W. Binni. Florence: Sansoni. 117 Hippocrates (2004). Airs, Waters, and Places. Trans. F. Adams. Whitefish, MT: Kessinger Publishing. In this work epilepsy is defined as a disease “connected to infancy” as it is children, in particular, who suffer from it.

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described customs different from theirs – in different styles, but both in admiration – in the effort to grasp the connections, not always evident, between historical events and man‟s vicissitudes. It‟s high time that men started, paradoxically, to “inhabit the world”, as Galimberti would have it (1994, p. 9): “they have never inhabited the world, but only the description that, in turn, religion, philosophy, and science have given of it.” [Emphasis in original] Maybe the time has come to immerse oneself into the world of contacts, relationships, and contradictions that permeate both the “self” and “the other”. Otherwise, we may end up investigating only in a virtual way and mythicizing what we take for real. In fact, this is like what happens during scientific meetings, when the discussion almost always focuses on a “mythical” patient, to the only benefit of an audience that listens and magnifies – in spite of itself – these projections. It happens that the conspicuous absentee is precisely the real patient, sometimes ugly, dirty, and bad [TN: a clear reference to Ugly, Dirty and Bad, a movie shot in 1976 by Italian director Ettore Scola], and talking to whom may take a great effort, whereas talking about whom is so easy! At the same time, there are people, with a different complexion than ours, who move more and more confusingly in a world unable to understand them. And yet, this is a world in motion, increasingly heterogeneous and coloured, crossed by languages, signs, flows and aggregates of ideas which, by “passing across”, continuously create and put together new cognitive maps, new groups, new identities, and new ways of knowing. The term across – by now quite familiar in this book – becomes a real epistemology, in the Batesonian sense of a new habit of mind to employ along paths of knowledge… Possibly, in this direction, the use of known paradigms such as identity, household, social mobility, culture, nature, and nation can help to understand things better – rather than simply encompass them in interpretive rules – precisely because they have a universal dimension and, therefore, can be applied anywhere. Transversality affects everyone and every place because it is a feature typical of everchanging and ever-adjusting cultural processes, with continuous recurrences and references. Once that the idea of an intact, pure and uncontaminated man (perhaps still existing in someone's nostalgic imagination) has died out, a complex world will take shape in a “mestizoed chaos”, as described by Gruzinski119 when he claims that the study of chaos has broken the ever more hermetic frontiers which enclosed specialists in increasingly narrow scopes and that studies of complexity stress the dynamics, the movement, the unpredictability, and the randomness of reality. In 1721, in his Persian Letters, Charles de Montesquieu wonders: „How can one be a Persian?‟ In 1999 Serge Latouche120 suggests changing the question as follows: “Doesn‟t an undifferentiated world, with no diversity, that is, without Persians, risk becoming totalitarian? That is why, rather than western and market standardization, we need a „pluriversal‟ world.”

118

Herodotus (1996; rev. 2003). The Histories. Trans. A. De Sélincourt. Ed. J. Marincola. New York: Penguin Classics. Gruzinski, S. (2002). The Mestizo Mind: The Intellectual Dynamics of Colonization and Globalization. Trans. D. Dusinberre. New York: Routledge. (Originally published as: (1999). La pensée métisse. Paris: Éditions Fayard.) 120 This quotation was taken from Carta, No. 2, 1999. On the issues that the question of the stranger arouses, see: Derrida, J. and Dufourmantelle, A. (2000). Of Hospitality. Anne Dufourmantelle Invites Jacques Derrida to Respond. Trans. R Bowlby. Stanford, CA: Stanford University Press (originally published as: (1997). De l’ospitalité: Anne Dufourmantelle invite Jacques Derrida à répondre. Paris: Calmann-Lévy). Starting from 119

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3.2. “ALBANIAN DRIFTS” In this chapter I shall relate an experience121 which I lived through personally in 1991, the year of the first “official” landing of Albanian refugees on the Italian coast, in the Puglia region. This report consists of notes that I took down when I was still overcome by the wave of emotions that the event aroused (and still does) inside me. That is precisely why I have deemed it useful to include these notes with no change or further comment, apart from the proposal that some put forward for the awarding of the Nobel prize to the Puglia people who, even after the end of the war in the Balkans, gladly took in Kurds, Kosovars and Roma refugees, people who were in search of anything, since they had nothing left, except the bitter awareness of being always persecuted. On 7 March 1991, when about 20,000 Albanians landed on the coast near Brindisi, in the Puglia region, epic events of the Bible were recalled (the plague of locusts) and fears spread about an invasion of new Turks (“mamma li turchi”),122 as an attempt to explain that an exceptional and extraordinary event had happened, such as people could never forget. Local authorities complained – and still do – with good reason. Lattanzio, the Civil Defence Minister then in charge, hedged. Finally, solidarity and emotion prevailed. Schools became emergency centres run spontaneously by groups of ordinary people, bound together by the only desire to help; car showrooms were made available to give shelter to hungry strangers who, nine years after the beginning of the millennium, ate bananas with their skin and swallowed suppositories, unaware of other ways to take drugs apart from the oral. The revival of values – not only religious – and the victory over consumerism and selfishness were hailed and all inhabitants of Brindisi and the Puglia region, in general, felt closer to one another and realized that life meant more than they previously had thought. Indeed, because of this unbelievable and marvellous solidarity, the proposal was made to award a golden medal to this small town of the Puglia region, which is definitely far from being heaven, with its notorious problems of unemployment, crime, and smuggling. Something had happened in people‟s minds and hearts. It was as if a new light had been shed on routine and the problems of everyday life. Even creativity was spurred anew: who can ever forget the showers set up in front of churches and the thousands of warm meals prepared by groups of volunteers, when the government action was still missing? Obviously, opening the front door and finding countless hungry people standing there was not an easy experience for anyone. The problem to deal with was the age-old one of hunger, a problem that existed then and still exists today, as television images witness, but was something that, until then, people had only passively “watched” and had been able to “interrupt”, at will, by simply pressing a button of their TV remote controls. But now, as Piero Gigante, a journalist working for the daily Quotidiano di Brindisi reports, a delirious irruption into “the harbour of everyone of us” has happened. Something ancient times, when hosts were given precious gifts, the authors ask themselves what, in our times, we offer our guests and what, in turn, they offer us to safeguard a kind of integrity which feeds on mutual exchange. 121 I am grateful to journalist Piero Gigante (from Brindisi) for his help. 122 See Corti, M. (1991). L’ora di tutti. Milan: Bompiani. The author deals with the imagination concerning the Ottoman army‟s raids and invasions of the coast of the Puglia region. See also Our Lady of the Turks, a movie directed by Carmelo Bene and based on his novel of the same name: Nostra Signora dei turchi (Milan: Sugar, 1966).

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really embarrassing is occurring: mayors and ordinary people are taking to the street because they do not want allegedly antisocial and different Albanians. This is a veritable loose cannon for Italy. It is a fact that the country lacks a real “culture” of prevention and, as a consequence, any unexpected event is doomed to turn into a catastrophe. One need only think of the Canadair aircraft that Italy sometimes has to borrow from France, the ships to recover the fuselage of planes at sea (always wrecked for reasons not to be known), borrowed from Great Britain, or the antipollution barriers, and so forth. However, if on the one hand, a negative and, indeed, rejecting attitude has emerged, on the other, so many Albanian children have been welcomed in Italian households: children adopted or taken in by friendly families, whom they do not want to leave any more. A question has arisen in Brindisi and elsewhere in Italy: is it right to join forces only to reject or to defend ourselves from the enemy of the moment? Why don‟t we join forces to obtain an efficient civil protection system? It is to be noted that, for example, in Brindisi there are very dangerous chemical plants and people are seriously worried about their safety and health, which has nothing to do with the threat of the “locusts from the opposite coast”. Obviously, the need for striking a balance and integrating these people in an appropriate way is unquestionable. And yet, it is also useful to start considering that sooner or later we will have to give up at least a few crumbs of our wellbeing. If we look beyond the tip of our nose, we cannot but see that the world balances and imbalances cannot be expected to stay as they are for long: the pressure exerted by southern countries is mounting up. When I listen to stories of all sorts of persons, from common people to entrepreneurs, from my “pub friends” to the engaged ones, I realize that there was, and there is, another way to face the problem. For example, I know that someone has turned into a sort of protector of Albanians and, by using this “title”, he makes telephone calls everywhere in the country, first, looking for a place where his protected ones can find a home, and then, monitoring how they are by all possible means. Does this mean that right in this place there are only heroes and saints? Brindisi is not in the least a quiet town, even though, in this momentous March, smugglers and prisoners have also given their contribution. Actually, my intention is not to assess the kind-heartedness of a town as against another, or claim that all Albanians are good. What can be claimed for sure is that here the habit of mind has changed: everyone has experienced an “internal movement” that he alone knows and owns. Truly enough, all these issues have contributed to circulate concepts such as solidarity and social values which had fallen in disuse or had been misused to the point of being spontaneously rejected. The “Albania event”, one of the most impressive mass migration events of the last few years (together with the fall of the Berlin Wall), can be considered as a dramatic and yet interesting rehearsal, useful to understand all subsequent migration flows towards mythical Europe. This imposing phenomenon has made us realize that we are no longer alone, not in religious terms (in the sense that God exists), for the benefit of believers, but in the sense that there are also the others, whom we can or have to take into account. Erecting walls and fences is not the only answer: we have to think differently, in ways that involve our Euro-centric behaviour, so slow to vanish. Is this an utopia? Or is it a dream? It is certainly both and a hope, too! A few years later. The lines that follow were written at the time and haven‟t been either corrected or updated, in the attempt to convey as accurately as possible the climate that prevailed then, following these events, and also to stress differences, if any, from what happens today.

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… Landings continue, more or less protected unscrupulous people smugglers are always in great numbers, and, meanwhile, war has broken out.123 Accordingly Albanians have been followed by refugees from Kosovo. All over the country integration areas have been created and solidarity initiatives have luckily been promoted everywhere. More sensitive ministers have succeeded to one another. Nonetheless, the organizational machinery, though started, does not seem adequate. The attitude has slightly changed. In the Puglia region people are more unconcerned about the different ones, i.e. immigrants, many of whom have been pushed into the arms of organized crime by the difficulty to find a job. Italy and Italians are working hard to challenge their own history, which has often showed a lack of organizational skills. From an exclusively psychological point of view, before the Balkan war, prevention and information initiatives were being carried out, especially in mountain settlements, targeting people considered to be the most endangered, that is, children and young women. The identity of a whole nation – proud and daring – (hence, the label of “country of eagles”) is under pressure. Migration is not the solution to all its evils.124 The limited experience recounted above, that I personally lived through, obviously opens a debate on many wide-ranging issues. Here, I shall dwell only on a few of them, in relation to which I shall make some “cultural provocations”. For example, what kind of culture will take shape? Besides being – as we have already seen – hybrid, mestizoed, and contaminated, culture shall necessarily include two important “infiltrative” features: transnationality, which means the crossing of different ways and worlds, and translationality (not only in religious terms, that is, passing from one confession to the other), which implies moving from one place to the other and vice versa. This process is to be a turnabout and go beyond the efforts made so far that have often only aimed to unity, thus oversimplifying all seemingly complex aspects and stifling differences in the name of the unity of the self. In the name of a supposed cultural hegemony, it is far from easy to bank up a river overflowing with languages, dishes, colours, and music that claim respect for differences and, instead, are often standardized. In this context, problems acquire not only cultural, but also ethical aspects: “the problem of the cultural unity of man is not a problem of knowledge but a problem in the use of knowledge, therefore an ethical problem” (H. R. Maturana).125 Going back to the initial issues of this chapter, I wish to recall my personal experience at a conference in Bordeaux (1998) whose original French title played on the double meaning of words: “L‟étranger, l‟étrange, 123

The Kosovo war (1999). For the time being, the “real” cause of the war is still unclear. Meanwhile, our vocabulary has been enriched with the following definitions: collateral effect = “secondary” death, in relation to a priority target (of death); humanitarian war = “justified” conflict that, consequently, can spread destruction and death in the name of a “principle” (?): we are witnessing so many acts of revenge and retaliation that some doubt that the war has a real “humanitarian” purpose. Indeed, in a way, it is as if we were back at the beginning, but with some more thousands of dead and some (!) more destroyed villages. Luckily enough, at some point reconstruction will start! 124 Plenty of works on Albania have fortunately been published (this is a way for the country to make itself known). Among the others, I wish to highlight one insightful novel by Ismail Kadare, considered as one of the greatest Albanian writers: Chronicle in Stone, trans. A. Pipa, ed. D. Bellos (New York: Arcade Publishing, 2007); a collection of studies, research data and reflections on Albania by Kosta Barjaba, sociologist at the university of Tirana, Georges Lapassade, ethnomethodologist at the Université Paris 8, and Luigi Perrone: Perrone, L. (ed.), Naufraghi albanesi. Studi, ricerche e riflessioni sull'Albania (Rome: Edizioni Sensibili alle Foglie, 1996). Finally I wish to point out another work by Kadare (the publication of which was completed during the war): Elegy for Kosovo, ed. P. Costantine (New York: Arcade Publishing, 2000). The underlying dramatic theme of the novel leads the reader into the history of a tormented country: the continuous quest for a national identity that events have never ceased to stain with blood since 1389. 125 Maturana, H. R. (1974). Cognitive Strategies. In Morin, E. and Piattelli Palmarini, M. (eds.), L’unité de l’homme. Paris: Éditions du Seuil.

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l‟étrangeté dans le champ de la culture et de la psychopathologie” [the stranger/foreigner, the strange, the strangeness/extraneousness in the field of culture and psychopathology, TN]. All reports focused on some major issues, including identity and belonging, and stressed the importance of the role of these issues in inducing our questioning of our clinical practice, in the cultural environment where we intervene. Actually each culture imagines, consciously and unconsciously, its singleness, its universality and “the strangers and the strange ones” through cultural representations. However, in this world of strange people and oddities, extraneousness and estrangement, also the psychiatrist risks feeling as a “stranger” in the face of new phenomena that narrow nosographic categories aim to “encapsulate”. This is what has been brilliantly stressed by Michel Palem126, well-known in the field of transcultural psychiatry for an interesting essay127 he wrote some time ago.

3.3. FAMILIES ON THE MOVE: CULTURE AND PSYCHOPATHOLOGY This chapter describes the connections that have shaped among migration, cultural and psychopathological processes in the context of the various experiences I have lived through in years of work with families in some Italian mental health services, where attendance of Italian and non-Italian immigrants is very high. If it is true that human culture, after all, is nothing else but the sum of mechanisms of adaptation to the environment and that psychic disorders stem from the inability to use them, then the migrant family is a typical example. The migrant family is very susceptible to cultural stresses, which are liable to create serious imbalances not only in its interactions with the outside world, but also within the family itself. In fact, migration processes entail great challenges and malaise ipso facto. It is necessary to consider the peculiarity of the Italian context where these processes have developed: by manifesting itself so rapidly, the phenomenon of migration has, indeed, taken most people by surprise and has contributed to the worsening of problems that were very complex by themselves. From a clinical point of view, the number of case records is still too low to allow drawing a general picture. Actually, the attendance of Italian hospitals on the part of immigrants is increasing. And yet, extending a treatment to an immigrant‟s whole family can only be achieved very gradually, because of the many obstacles that add up to the reluctance which normally emerges in the family as soon as the need for extending the therapy is mentioned. In order to include the psychopathological dimension of migration128 into an interpretive grid, albeit narrow, a few important parameters shall have to be used. The first one is the 126 127 128

Palem, M. R. L‟étrangeté du psychiatre. In Actes des journées internationales de formation de Bordeaux (October 1999). Palem, M. R. (1968). L‟ethnopsychiatrie: science ou carrefour? In Thoret, Y. (ed.), L’évolution psychiatrique. No. 33, p. 139. Mayenne: Jouve. Concerning the problems related to the psychopathology of migration, I recommend some writings in Italian, including: VV. AA., Migrazione e salute mentale in Europa, in Antropologia medica (No. 4, 1998); Terranova Cecchini, R. and Tognetti Bordogna, M., Migrare. Guida per gli operatori dei servizi sociali, sanitari, culturali e d'accoglienza (Milan: Franco Angeli, 1992); Frigessi Castelnuovo, D. and Risso, M., A mezzaparete (Turin: Einaudi, 1982), always topical; Risso, M. and Böker, W., Sortilegio e delirio (Naples: Liguori, 1992); Frighi, L. and Cuzzolaro, M., Immigrati a Roma da paesi in via di sviluppo, in Rivista sperimentale di freniatria (XI suppl. to No. VI, 1987, pp. 1403-1497); Andolfi, M. (ed.), Terapia familiare (No. 54, July 1997), on families in a multiethnical society; Connessioni (Passioni, migrazioni, povertà), No. 2, 1997; I fogli di ORISS (Il disagio della globalizzazione), 7/8, 1997; Beneduce, R., Frontiere dell’identità e della memoria (Milan: Franco Angeli, 1998).

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body, that is a direct communication vehicle for a “physical” malaise which, however, is often the initial symptom of a psychic disorder. If we succeed in establishing a relation, the symptom shall gradually loose its “physicality” and become an ill body, or rather the disease of a “body-existence” (Callieri, Maldonato, and Di Petta 1999). The second parameter is time, a very important one because it underlines the “suspended” condition where immigrants live, that is, the noisy and unpleasant ticking of two invisible clocks, which continuously remind them of the presence of a “here” and a “there” dimension. As we know, each individual conceives his own history not only in time, but also in space, through a specific territoriality, which is essential to confirm, inter alia, his “being-inthe-world”. Another major parameter is the relationship between the self and the group: it defines the ability/difficulty, at first, to fit into one‟s community of origin and, then, to establish relations with the destination country (from this point of view the community of origin can at once protect and isolate its members). Both the family and the community play a decisive role at the onset of a specific psychic disorder.129 How can these situations be faced at best? Is it easier to intervene during a crisis, in a general hospital or in a unit for psychiatric diagnosis and care, since, in this way, the contact with the patient acquires an “institutional” character (that is, the territorially relevant medical team, notified of the patient‟s admission, shall take care of him)? An alternative is the outpatient clinic, where the immigrant is sent by relevant reception centres (Caritas, organizations of lay volunteers, unions, and so forth). The first observation that can be made in the frantic context of migration is that within the cultures to which people suffering from psychic disorders belong the role of family and the group is central (although with different shades). These individuals are united not only by affection, but also by solidarity, mutual help and respect: one need only think of the importance of figures such as the elderly, who are protected and feared, or the bond between brothers (on this point, we shall see the story of Mircea and his Romanian brothers) which is based on mutual help. The problems resulting from the contact with a new culture (publications from other countries with a long experience in this area abound)130 are a tough test for the pattern of the family and its compensatory mechanisms of adaptation, as well as for the therapist. This framework, albeit partial, can provide the setting where the symptom manifests itself as a physical disorder which is immediately detectable and, thus, connected to the body. In this case, the body represents a visible external border, even though it is related to something that cannot be touched. “I feel pain everywhere” can describe the onset of a suffering which is completely unknown and yet 129

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It is well-known that looking after an ill relative is commonplace in immigrants‟ countries of origin (one need only think of the experience of the Fann psychiatric clinic in Dakar, Senegal). See: Diop, D. and Dores, M. (1976), L‟admission d‟un accompagnant du malade à l‟hôpital psychiatrique (in Africa Journal of Psychiatry, No. 1); Collomb, H. (1973), L’avenir de la psychiatrie en Afrique; Collomb, H. (1978), Les modèles de la psychiatrie africaine, a contribution made at the Symposium of Transcultural Psychiatry held in Havana on 2026 February 1977 (in Psichiatria e scienze umane I, No. 2, April-June). Tobie Nathan‟s theoretical-clinical experience is noteworthy. A pupil of G. Devereux, he created the first ethnopsychoanalytic consultation service in France (1979), at the paediatric psychiatric unit of the Avicenne hospital in Bobigny. In 1993 he established - and directed until 1999 - a university centre for psychological support to immigrant families in the UFR of psychology (Clinical and Social Practices at the Université Paris 8). The centre is the first university site of psychological clinic ever set up within a UFR or a psychology department. See: Nathan, T., La folie des autres (Paris: Dunod, 2001; first printed: 1986); Nathan, T. and Stengers, I., La damnation de Freud (Paris: Éditions du Seuil, 1997).

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makes itself visible through the only certain fact: the body. The body becomes the immigrant‟s “unique asset”, something real – notwithstanding the precariousness and fluctuation which permeate it – that can manifestly be a shield against uncertainty, feelings of guilt and threats more difficult to define. The symptom is, accordingly, a “line”131 – at once an opening and a closing one –, a way (epiphanic) of announcing something which is about to appear. Though it is true that the message contained in the symptom reminds of a bond with elements such as health and disease, still it implies a wider communication process, inherent in any system of knowledge. It is an interaction with permeable boundaries where mythical and real horizons intertwine, within specific cultural frameworks and difficult access attempts. All this world often manifests itself as pain, visible and easy to locate: the symptom (“It hurts here”, the patient says, pointing out a spot on his body). As I have already noted, the symptom is often the onset of a deeper malaise. On this point Leff (1988) maintains that what distinguishes delusions and hallucinations from other symptoms of physical diseases is the different degree of dependency from cultural differences and not the different nature of symptoms. In the final analysis, any psychic symptom has to be assessed in relation to the patient‟s cultural context. Accordingly, in the face of such problems, we have to take a pause and focus on the vast area which the symptom frequently relates to. Then, our intervention – albeit “micro” – has to acquire a “macro” dimension, which implies the activation of all the resources of the network lying outside the mere and limited context of the treatment, that becomes itself a network. The limits and the thresholds that separate cultures from one another can thus play the main role and, indeed, trace out a well-defined territory: the place of care. Such an effort necessarily requires changing the point of observation. Actually, only by realizing that each of us has his own “cultural niche” (Leff, ibid.), can we review our arguments and convictions in relation to those of other cultures or subcultures. The risk, or rather the opportunity, is succeeding, through this emphasizing process, in “demystifying”132 our beliefs, the notion of mental disorder itself, and the idea of care which we entertain and apply daily and have never really wanted or been able to question. The contact with malaise and distress – that immigrants often manifest somatically rather than psychologically – can open up opportunities for observing how symptoms present themselves in other cultures, whether they are treated differently according to the specific culture and whether culture can affect them.133 When discussing about migration, Zolla (1994, p. 96-97)134 gives a description of the Sioux: “He, too, wishes to get into an intimate relation with air, identify himself with it […] he offers himself to the unknown, believes in destiny, and lives on the edge [… ] It is certainly an uncertain path, but it is the one we have to tread, as resident therapists, who deal with wandering patients.” He adds (Zolla, ibid., p. 110): “Starting from these traces, let us not hope to approach the high perspectives that 131

Cf: Ancora, A. (2003). “Sintomo” and “Transculturale”. In Telfner, U. and Casadio, L. (ed.), Sistemica. Voci per un percorso epistemologico. Turin: Bollati Boringhieri. 132 On this point, in Demystifying Mentalities, Lloyd asserts that today‟s sociocultural evolution is a dialectical movement of historical actualizations of evolutive accelerations that demystify different mentalities. 133 Leff considers these questions fundamental for any psychiatrist who, no matter his background, is and will be increasingly involved in the culture-disease relationship. See: Leff, J. (1988). Psychiatry Around the Globe: A Transcultural View. London: Gaskell. 134 Zolla, E. (1994). Lo stupore infantile. Milan: Adelphi. Zolla was a philosopher and a writer born in Turin from Blanche Smith, an English musician, and Venanzio Zolla, a painter of Franco-Italian origins. He died in May 2002 at the age of 76. He studied symbolism in religions (mainly the eastern ones) and gained success in Italy as a novelist and a translator of Sade‟s works. In 1974 his work Le chamanisme indien dans la littérature américaine was published in France (Gallimard).

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migrants can reach at the end of their paths, when they invent a syncretism. Nor can we hope, besides these linguistic remains, to get close to this internal world of migrants gliding among foreign patterns, swept by the wind, and near to, and yet unaware of, rescue. If we wish to advance towards rescue, however, we should assimilate this condition.” Concerning the way the relationship between the psychiatrist and the immigrant develops, it is to be noted that it is an encounter between two different cultures, where there exist specific concepts of malaise and symptoms take on a particular function. The first question to ask oneself is whether, as a consequence of migration, the representation of the disease has lost the meaning it had in the patient‟s country of origin, in relation to his family and his community, and whether it has taken on a new one in the new culture. The objective must be to grasp connections, and not only differences, especially when the psychiatric worker finds himself in unusual “territories”, such as migration, in a society that is becoming, with a great effort, more and more multicultural.135 As a consequence, if on the one hand the definition of this new scenario (increasingly large immigrant families, mixed couples, and so on) is still in progress, on the other the need to broaden clinical horizons through cultural and ethnic support – and, obviously, a different habit of mind – is urgent and immediate. Moreover, as has already been noted, the cultural heritage that the immigrant family takes along, consisting of myths, beliefs, and customs, has to be taken into account, without, however, indulging in anthropological investigations, often far too muddled. Such a varied and hermetic picture can sometimes serve as a shelter to hide the real functioning patterns of the family system, the cultural aspect of which is the subsystem. Being familiar with cultural patterns in general, and traditional or ethnic models in particular, is an additional tool that the therapist can use to enter seemingly inaccessible situations, as well as an opportunity to find a concrete solution to all or some of the problems that the psychic disorder hides. Paradoxically, the therapeutic context can also be a place where different and diversely aggregated cultural values and rules can be learnt. It is well-known that, when dealing with certain families, a gestural, nearly physical, language is able to convey meaning better because such a language is easier and understandable by everyone, thus allowing to do without such statements as: “I cannot understand you because I am not learned like you, Doctor” and (if the interlocutor is foreign): “I don‟t understand what you are saying.” Resorting to theatrical gestures can also be useful to establish a direct and immediate communication. Apart from one‟s therapeutic style (that, as we know, cannot be taught), finding communication modes as close as possible to the ways of interaction of a given family system can be a real opportunity for any therapist who never gets tired to try all different security codes of the systems key he uses. From my encounters with immigrant families, especially when I have succeeded in creating a common story with them, I have drawn the following suggestions: 1. Listening to the ticking of the two clocks by connecting dates and steps to the evolution of the problem. 2. Defining the malaise by associating it to the different degrees of reception – whether presumed or real – that the patient has met with 135

A multiethnic society is already there where there are people from different cultural and religious backgrounds, with their own way of dressing, meals, music, and meeting places. As I have already mentioned, an example of this can be witnessed on Fridays just outside the mosque of Rome (the largest in Italy), a city which can be considered as the cradle of Catholicism: a varied and tidy swarming of so different ethnic groups, countries, minds and thoughts. The story of the construction of the mosque is very curious. After completion, its opening was delayed for a long time because Roman religious authorities realized that the minaret was higher than Saint Peter‟s dome! This was unacceptable! The then Prime Minister said: “Imagine if a Catholic church were built in Jeddah (Saudi Arabia)…” When the height of the minaret was finally reduced, the mosque opened.

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and by checking whether he has run into further obstacles, due to political, religious or other reasons, or, instead, integration opportunities have arisen. 3. Noting any differences in the experiences lived through by single family members at the time of their first journey and subsequent returns/visits, investigating desires and expectations in relation to a final reunification. 4. Encouraging families to imagine future scenarios; creating conversational contexts in order to highlight areas of their history where room can be made for their aspirations, desires and choice opportunities which are compatible with their life styles, across two contexts. 5. Investigating the degree of involvement in past events, for each member of the family, stressing emotional differences never emerged before, in order to develop a meta-history beyond the specific meaning of cultural values and rules. It is also important to separate single family components and generations from one another and underline shades and details of a spatial dimension where experiencing different sensations and ways of observing is possible. From this perspective, the story that is being written or rewritten can be further developed, a story that initially is so narrow as to make it impossible to open up to new horizons or is hidden by the original problem. 6. Assessing whether and how much beliefs, values, myths and world views affect the symptom. 7. Creating the conditions favourable to perform an analysis of resources, differentiation processes, processes of acculturation, and resistance to these phases by closely examining the adaptation skills that an individual or a group of individuals employ when they have to leave behind their life styles and traditions and integrate “other” habits, customs, ways of interaction, and patterns. 8. The encounter with the family and the contextualization of “other” realities can be a means to know each family member‟s mental constructions and ways of approaching the migration process. 9. Mobilizing attitudes and activating resources that have never been explored before can trigger critical mechanisms in the face of an integration so far considered unattainable. Finally, a re-connotation of the migration process as an existential challenge can increase the family system‟s awareness of its weaknesses and strengths as well as the paths that can be trodden together with the therapist. The goal of transcultural consultation is not helping to speed up acculturation processes that are in progress, rapidly cutting roots and other important bonds with places (not only geographical). It consists, actually, in verifying time in order to evaluate the real distance which is to be crossed to try and enter the new reality. The encounter can indeed provide the opportunity for assessing the family components‟ emotional and physical “position”, that is, the way they belong to old and new contexts. The clinical conversation can, indeed, become a space where it is possible to create the preconditions for taking choices with a clearer mind and make “physical” – to the benefit of the whole family – the opportunity to observe from another viewpoint their own degree of integration and transcontextual difficulties, if any136. Accordingly, from such a difficult and gradual differentiating operation it may result that migration experiences lived through by men are different from women‟s and, similarly, there may emerge divergences among different ethnic groups and individuals belonging to different social classes or different generations. One of the most difficult tasks is assessing the impact of cultural differences and their possible use in therapy. Clearly, there are times, during these encounters, when the therapist‟s notions, beliefs and moral and political ideas (for example, what opinion he has on migration, as an ordinary citizen) are revealed or even jeopardized. 136

Transcontextuality is an opportunity for a deeper exploration, a passage through a higher number of cultures and lived experiences where difficulties vary in relation to the specific phases and family members.

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How can this be related to all the rest and, in particular, to the structure of the family group with whom he is attempting to co-develop a story? Thought aloud and followed by a question mark, and marked by a precarious approximation and the need for continual adjustments, such considerations mainly aim to stress the limits in action/thought that anyone confronted with these complex phenomena meets with. At the same time, they aim to make the therapist more aware of the peculiar, small, and new reality he is facing, the building of which falls within his responsibility, too. He should always remember that this is a microcosm, a tiny – albeit significant – fragment of a macrocosm, that might reveal itself (if faced without the necessary awareness) – as an endless space. Actually, from a realistic viewpoint, considering the observations made so far, the encounter is characterized by very bright colours and deep emotionality. Therefore, it cannot only be made up of the immigrant family‟s “lists of grievances”. For reasons connected to the most recent phase of its story (when the family has been forced to migrate), the family is “authorized” to create expectations each time a new event occurs, including the consultation provided by the therapist. In this regard, a possible problem lies with the therapist himself who might be induced to fuel false hopes, whereas, in his role as builder of realities, he should catalyse resources and mitigate excessive idealizations. This course of action can clash against a nearly messianic attitude based on anticipation or excessive confidence that – unless it is mitigated and put back into a real, yet not necessarily harsh, perspective – can only end up confirming the family‟s mistrust. This would mean for the therapist to usher in the well-known “threat from an environment considered hostile” that immigrants often feel and that he believed to have already sent away. Consequently, he is advised to ask himself to what extent this feeling has affected the initial clash between two cognitive systems (therapist and family) and whether he has succeeded to get close to “cultural codes” (described by Robertson)137. It is important to note that also the concepts of family, culture, and therapy have changed and have become the subjects of new sciences (second order cybernetics, constructivism, constructionism, and so on). Sometimes family therapy has a hard time dealing with the cultural challenges raised by the family, or rather what we are used to consider as such. As I have repeatedly pointed out, culture is not only a mobile and nomadic term, but also a concept on the edge, an oscillating one, that we cross each time we wish to know someone. In chapter 1 I described particular “thresholds”, where boundaries are permeable to open minds or to attitudes which are close even to internal customs.138 These particular territories, where the exchange of suffering, experiences, and ways to face events is more deeply felt, are crossed by “transeundi”, cross-border commuters, migrants, and border people. This picture has been described by Bastide as a “pathology of transition”,139 indicating “transitional” social phenomena, such as urbanization and the setting up of new religious groups or family groups. In these areas stories, or rather traces of stories, intertwine, and the therapist can work on

137

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Here reference is made to Ronald Robertson‟s concept of cultural codes, as reported in Sociologia dei conflitti etnici by Cotesta (Rome; Bari: Laterza, 1999, pp. 38-39), that is, “in terms of deep and implicit assumptions on the relations between the whole and parts, individuals and society”. Concerning the notion of “internal customs”, see the commentary to the documentary L’incontro con gli sciamani siberiani by Alfredo Ancora (Rome: Edizioni Video SD Cinema, 1996). To describe the kind of “image” a melting pot of peoples and cultures provides, the French sociologist (1965) quotes Paul Claudel who describes America as a new Eucharistic table, where different peoples (Indians, blacks descending from deported slaves, whites, Spaniards‟ descendants, Italians, Poles, etc.) communicate through work and bread.

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them, attempting to give a meaning to problems presented in a weird and chaotic way and to relate them to a culture that is not always easy to understand. Geertz (1995, p. 51)140 points out that: “understanding a form of life, or anyway some aspects of it to some degree, and convincing others that you have indeed done so, involves more than the assembly of telling particulars or the imposition of general narratives. It involves bringing figure and ground, the passing occasion, into coincident view.” In order to create a story, apart from collecting data, information, and emotions, it is useful to consider with attention also the elements that are taken for granted and are lived through carelessly. At the time of Herodotus, a veritable expert in narration and tales, the word history stood for research, analysis, spirit of investigation. Due to the abundance of details, sources, peoples and countries described, and, especially, the author‟s attitude, Herodotus‟s works could certainly earn him the qualification of “ethnologist”. As a quest for one‟s own identity and an account of one‟s own past – which one thinks to describe more or less accurately –, history is also a process of reconstruction: data and dates reveal one‟s own way to think about one‟s suffering through cultural patterns which are often different from ours. Then consultation can become a space for a cultural encounter, as well as a space of knowledge, where experiences can be exchanged in (borderline) areas, within boundaries to cross on tiptoe. Standing on the threshold is, therefore, more important than erecting therapeutic “fences”: in this perspective, fences are necessarily mobile, barely defined as they are by outlines, light and shade, and gradations which are often applied only with gestures. Our culture, which is mostly based on words, has failed to teach us how to use non-verbal means of expressions, i.e. the stare, the posture, and regenerative silences. In this regard, in his fuzzy thinking, Kosko141 (1992), an original mathematician and philosopher, interprets facts of a cultural nature using a “fuzzy logic”. He stresses that it is all about measure since facts are always, in a certain measure, fuzzy, that is vague, blurry, which evidently does not mean their being slippery, but their having outlines difficult to grasp and many possible frames. Actually, creating therapeutic realities of this kind, with many interstices and changing limits, would require the skills of a border therapist, such as the shaman, a veritable threshold man, used to work in inter-zones, on a rope tightened between “here” and “there”, and ready to enter the world of suffering, a technician of the “beyond” who can also travel into and out of his own self. At this point, wishing to suggest a working path with families based on a transcultural approach, I shall illustrate a few thought-words which make up such a path or rather its vocabulary: a) Thinking transcultural. In the face of these moving families/realities, the worker has to take a flexible and mobile attitude, so that he can cross boundaries and walk in unexplored fields. Consequently, the use of usual paradigms could be inadequate. The suspension of certain categories can be an asymmetric way to approach someone already living in double times and spaces. Thinking transcultural also entails trying and adopting a “non-centralized” way of observing in the knowledge process. This 140

Geertz, C. (1995). After the Fact. Two Countries, Four Decades, One Anthropologist. Cambridge, MA: Harvard University Press. 141 Kosko, B. (1992). Neural Networks and Fuzzy Systems. A Dynamical Systems Approach to Machine Intelligence. Englewood Cliffs, NJ: Prentice Hall.

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Alfredo Ancora means that the therapist has to get ready to cross unknown cultures and lands: he shall have to provide his own mind with wheels to walk, rather than wings to fly away, and be willing to contaminate and, in his turn, be contaminated or infected. Along this path the therapist may happen to find himself in other contexts, dilute and widen the problems initially presented, and also change his own way of working. Results then can be tangible, whether the context is a cultural encounter with or a clash against the other. b) Acting transcultural. Consultation and therapy within a selected project must have, as a reference model, systems thinking and, as a scope for action, an active territorial network. The encounter becomes a space (melting pot of stories and tools) where the path to walk along with the family starts. Here the clinician can observe and grasp habits, customs, ritual signs, behaviours of adaptation, and specific aspects of communication. In short, the two phases of thinking and acting transcultural are the interface of a single attitude/approach: thinking global/acting local, thinking about the pluriverse/intervening on the universe. c) Trans-context. The Latin etymology of transcontext has a great relevance: the word contextus means “to unite”, “to connect each other”. Context can be defined, literally, as a group of ideas and facts contained in a writing, that help determine the sense of a part or a word in it. Trans, as has already been noted, entails different meanings: between, beyond, across. The term transcontext is employed here to refer to a particular way of living across multiple contexts, where different life styles develop in relation to a model that connects various cultural, geographical and emotional worlds. Transcontext is an inter-zone, the condition of someone who is in contact with different cultural systems, lying between two systems of meaning, the original and the new one. Bateson defines the word “transcontextual”142 as follows (also hinting at the possible problems it implies in terms of psychic disorder): “It seems that both those whose life is enriched by transcontextual gifts and those who are impoverished by transcontextual confusion are alike in one respect: for them there is always or often a double take. A falling leaf, the greeting from a friend, or „a primrose by the river‟s brim‟ is not „just that and nothing more‟. Exogenous experience may be framed in the contexts of dream, and internal thought may be projected into the contexts of the external world. And so on. For all this, we seek a partial explanation in learning and experience.” Transcontextual syndromes are manifestations having in common the tendency to transfer elements, ways of behaving or meanings outside the original context, through steps which are not always painless. If we think of those families who suddenly find themselves facing very hard times (migration, post-war syndromes, etc.), we can easily see how difficult it can be for them to decode meanings and signs coming from the new contexts and create new life styles. Hence, they develop inadequate behaviours of maladjustment and suffering. For these reasons, the therapist‟s task can be likened to that of a culture broker, that is, someone who comes close to a family group whenever they have difficulty in recognizing the values of their own culture or show to have lost their sense of identity. In this light, transcontextuality, i.e. the transition from a context to another, defines the difficulty to find connections and “bridges

142

Bateson, G. “Double Bind”. In Steps to an Ecology of Mind, Part III, p. 272.

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between” that turns into a syndrome, that is, the visible revelation of a fracture. In other words, it becomes the context where the therapist can develop a story with the family, outlining new maps and a new vocabulary made of new names, the first of which shall be “home”, or something that can become, over time, more and more similar to home.143 This process involves especially immigrants, nomads, and refugees, but it can also concern those individuals that, although actually “belonging” to the culture of the place where they live, come from a world of subculture, marginality and uprootedness, which means that they are often considered as strangers. The situation that typically emerges in the context of migration phenomena is the following: on the one hand, the immigrant needs to maintain his roots; on the other, it is necessary for him to integrate his new experiences, link his previous life to the one in the new place, learn to be here with the awareness of having been there. The stages of this process can appear self-evident. Yet, they often advance by leaps, with connections that cannot be restored, and specific times that the therapist cannot catalyse by speeding up phases of history and development. The therapist‟s real task is helping families to write a story, showing them the difficulties entailed by this transcontextual process, and helping them to understand to what extent they can make their own desires and expectations match the complexities of a life style across two worlds. These difficulties arise especially in the case of a family reunion, when the need emerges for a redefinition of roles (who was here, who was there), on account of the new situation, as well as a recontextualization of family bonds and groupings. (The importance of the temporal factor is also to be taken into account because, in the meantime, “those who have stayed” and “those who have left” can appear different in everyone‟s expectations, and the same applies to the importance of realizing who has left earlier and why and who has left later and why.) It is indeed true that, more or less consciously, all the family members have participated in the new story – albeit in different ways –, but the most painful part of it has to be shared by all. Actually, the family‟s cultural heritage contains all combinations of adaptive behaviours and common experiences stemming from sharing in a variety of different contexts: ecological situations (rural, urban and suburban), philosophical or religious values, nationality and ethnicity, family organization types, social class, employment, migration paths and acculturation states, and also values deriving from the sharing of historically similar moments or particular ideologies, as argued by Hansen and Falicov.144 In other words, culture is not a collection of data that we own or a legacy from past generations that has remained unaltered through the years, but a dynamic corpus, a continuum

143

See also Heimat, an impressive movie by Edgar Reitz (a gigantic project originally developed to be broadcast on television consisting of 11 episodes, in the first part, and 13, in the second) whose title is a German word meaning “home”, something to hold onto, to cherish in one‟s memories, to dream about when one‟s home no longer exists or is far away, and, also, something priceless and, therefore, one‟s homeland. Through a family saga, the director tells the history of Germany, from the inside, in an extraordinarily moving and unusual way, “by exploring the territories of the country‟s domestic dimension through the two symbolic figures of our human odyssey: the one who leaves and the one who stays, the one who dreams about a different world and the one who realistically accepts reality as it is” (Di Giammatteo, F. (ed.) (1996). Nuovo dizionario universale del cinema. Rome: Editori Riuniti, pp. 1098-1099).

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– notwithstanding all the difficulties and the need for adaptation. Even in its more stereotyped aspects, the family‟s cultural organization can be both a key to inaccessible territories and a constraint that might also delay the resolution of problems. We should bear in mind that any organization is at once transformation and formation (morphogenesis), as maintained by Morin (1992). The psychic disorder which emerges in such a framework can also be, as Devereux states,145 a “standardized system of defences” that act as veritable cultural protections and enable the overcoming of conflicting situations.

3.4. METROPOLITAN PATHOLOGIES: POSSESSION SYNDROMES AND DEMONOPATHIES IN ROME, THE ETERNAL CITY For quite some time we have been witnessing a true revival of psychopathological phenomena which remind us of themes, stories and lived experiences that we believed belonged to the past. Actually, at the beginning of the third millennium, jinxes, possession syndromes, and magical practices, that in the past belonged only to the rural world, are widespread in urban and metropolitan contexts. Apparently, issues concerning the supernatural or the eternal conflict with evil forces are to be set against a true demonological background, which is necessary for anyone who wishes to approach such psychopathological phenomena. In his still unsurpassed study of 1917, Otto146 draws our attention to the term “demonic”, which means anything that irrationally suggests the presence of the holy and the numinous. In this book this term shall be used to refer to a varied and complex phenomenon related to levels that pertain to the specific cognitive-experiential sphere and the world view of an individual who, in this practical-noetic framework, becomes convinced of the existence of something supernatural which is beyond the world of senses. Obviously, entering into a discussion on issues with very vague boundaries raises plenty of questions, including that on the nature of the connections between magic and the holy. For a start, I shall define these connections as multiple, intertwined, explicit, denied, and self-evident, just to provide a few connotations. Without pretending to simplistically sum up themes deeply rooted in man‟s history, I wish to point out that magic has always been regarded as something fluid, never outdated, indeed, as a constant and a bond between yesterday and today, between the world of the primitives and the world of modern man, science included (which originated from magic, and not vice versa). One need only think of the high consideration in which the fathers of western scientific thinking (Newton and Kepler, to name only a few) would keep magic. An uninterrupted river flow which waters flowing from always varying springs poured in, in the course of time… 144

Hansen, J. C. and Falicov, C. J. (eds.) (1983). Cultural Perspectives in Family Therapy. Rockville, MD: Aspen Systems Corp., pp. xiii-xix. 145 Devereux, G. (1970). Essais d’ethnopsychiatrie générale. Paris: Gallimard, p. 49. 146 Otto, R. (1958). The Idea of the Holy. Trans. J. W. Harvey. New York: Oxford University Press (originally published as: (1917). Das Heilige. Gotha: L. Klotz). Cf: Ries, J. (1985). Les chemins du sacré dans l'histoire. Paris: Aubier.

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Instead, the holy has always had to take on more rigorously defined and set roles, as if its non-definition had to remain such, because, by eluding the time dimension, it could stay there, strong, unshakable and, especially, immutable…In the light of my previous observations, it is useful to dwell on one of the main obstacles that whoever works in this area usually meets with: one‟s habit of mind, which obviously affects and is affected by the phenomena under observation. The worker often follows a too rigid, self-assured and classifying way of thinking, unable to separate dichotomies such as mind-body, nature-culture, and, precisely, sacred-profane. The result is often jumping out of the frying pan into the fire, that is, passing from irrationality or an extreme quest for transcendence to a far too empirical simplification. Actually, we need to acknowledge that we are before age-old and never unravelled knotty problems which tangle knowledge or, rather, the way we think we know. Hence, there is the need to approach the world of the sacred with no excessive deference or prejudices (we cannot ignore that most of our culture and the air that we daily breathe are impregnated with “religion”). As Yerushalmi147 writes on Freud‟s Moses, the true essence of religion, that is, its mysterious power to arouse and maintain for centuries, even millennia, the loyalty of men and women, is out of our comprehension. In order to face such a debate, always topical, it may be useful to access the sacred as if it were a real scope of knowledge, a sort of space at once ideal and real, metaphorical and literal, where “fools rush in” and “angels fear to tread” (Bateson and Bateson 1988). In the face of these issues, it is necessary to “act and think on tiptoe”, not out of an exaggerated fear, so much as to be able to gather all information and messages that can add to further knowledge. However, this cannot be a safeguard against the contradictions and the paradoxical aspects inherent in the theme under discussion, which means that I shall necessarily find myself endeavouring to say the unsayable, disclose the undisclosable, express the inexpressible. Actually, if about seventy years ago de Martino (1941), a modern and unequalled master of religions, stated that our civilization is going through a crisis, a world is about to shatter while another is emerging, forty years later Bateson (1984) – who dealt with studies and investigations of a completely different kind, but was incredibly attuned to and synchronous with him – ideally “replied” that old beliefs provide no more explanations or assurances and that the obscure perception of this obsolescence is central to the epistemological nightmare of the twentieth century. Our task is disclosing new aspects of today‟s crisis, precisely starting from the need or the willingness to try new ways of knowledge and knowing ourselves, as if dealing with the sacred could help us to better observe what happens inside certain processes that we believe happen always outside us. This framework provides me with the opportunity to describe certain clinical situations related to the aforementioned topics. I work in a territorially-based public service facility148 located in the Roman suburbs where many immigrants live and social malaise is on the rise. 147

Yerushalmi, Y. H. (1991). Freud's Moses: Judaism Terminable and Interminable. New Haven, CT; London: Yale University Press.

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Here, I receive patients every day and I am in contact with every kind of psychic disorder stemming from problems of marginalization which, in particular (but not exclusively), involve the young. In this cultural context, at once disrupted and varied, family groups and parents observing life rules and beliefs of their communities of origin are strongly represented. I regularly encounter people affected by syndromes related to supposed “jinxes” which they claim have been put on them, possession syndromes or mystical delusions, and, in general, religiously-based hallucinations. These disorders can be grouped together as “demonopathies”. Not far from me there works Father G., a highly regarded exorcist. I have never had the opportunity to study, or even merely observe, his exorcist practices, but I have been able to reconstruct them through my patients‟ reports. It is difficult for me to express in words what sharing my territory with a rival of this kind makes me feel. However, after so many years, Father G. has become a sort of permanent mate, a constant “presence” in my work. In fact, our field is common, with outlines that are usually undefined, where the psychiatrist and the exorcist end up sharing their professionally ambiguous role of “soul healer”, encompassing the search for answers in the face of continuous calls for help. For anyone who deals with such disorders the devil is certainly nothing new and, indeed, is a constant feature of my patients‟ stories. Actually, many of my patients have lived through a common experience: being possessed or attacked, in a certain phase of their lives, by unchecked alien, indeed evil, forces, that, since then, have made their lives more uncertain, fragile and exposed to undesirable phenomena. Since the very first manifestation of the crisis, to them life has become unbearable just as is unbearable “having to continuously fight back the ever-present sensation of „being acted by‟ ”.149 148

This facility is one of the many mental health services (in Italian: C.S.M., centro di salute mentale) established in Italy after the closing down of mental hospitals. Passed in 1978, as the first of its kind in the West, the bill 180 (also referred to as “the Basaglia law”, after the name of the psychiatrist who supported it) ruled the closing down of psychiatric hospitals and the setting up of departmental psychiatric services divided into mental health services, located in the different areas of each town, and psychiatric services for diagnosis and care (in Italian S.P.D.C., servizio psichiatrico di diagnosi e cura), available in general hospitals (for patients in the acute phase). 149 The sensation of “being acted by” is directly connected to the “crisis of presence”, on which de Martino (repeatedly quoted herein), presumably the greatest historian of religions in Italy, worked in an exemplary and thorough way. Unfortunately, his name is known almost exclusively to ethnologists, and yet his studies are, still today, fundamental pillars in the psychiatric investigation of such phenomena. Indeed, in his works on magic and tarantism (a phenomenon widespread during the Sixties in the south of the Puglia region whose manifestation was connected to the conviction of being bitten by a tarantula – a kind of spider –, as a result of which a state of deep malaise emerged, with psychomotor agitation, etc.), de Martino observed that in certain socio-cultural contexts the (psychiatric) disorder was represented in magical terms, so that the ill person identified his disease with possession by obscure forces and described healing as “feeling to have recovered”. In this perspective, understanding the magical representation of the disorder rules out the use of the traditional medical approach (symptom, etiopathogenesis, diagnosis, prognosis, therapy). As a matter of fact, this approach would necessarily imply considering the “disease” as a collection of data, rather than a process, which is what it actually is, a process that is more cultural than pathological and that manifests itself not only through the patient‟s sensations, but also through the behaviours his condition determines inside his group. Hence a conclusion which might appear paradoxical: the “medical” representation of the disease, so radically based on observed data, is altogether unrealistic here. Indeed, for the sake of concreteness, a magical interpretation of the disease would be more appropriate.

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My clinical experience has not been confined to Roman suburbs. I have also worked in other parts of the country, including Sardinia, the Puglia region and Latium, where I had the opportunity to deal with life stories that, ever since, have given me more than a cue in my activity. Of the many clinical cases monitored in Rome and elsewhere, I shall now report Antonia‟s. A 40-year-old woman migrated from the Calabria region to Rome, Antonia feels to be possessed by evil spirits that she cannot fight back and that have been causing her much suffering for a long time. Her disorders began when Antonia, freshly married, was 28. Though it is true that feeling to be possessed by these forces does not help her to live normally, still it is not traditional medicine – that regards her as a “mad woman” and describes her troubles as incomprehensible – that can help her. Indeed, after various hospitalizations, she reluctantly turns to the service where I work (actually, she is brought there). In fact, she does not believe that we can understand her. She feels to be besieged on all sides: by evil forces, invisible, and yet so dramatically present to her, and by science which wants to classify her by means of diagnostic categories that are not in the least beneficial to her. Antonia has shut herself off from the world by refusing to communicate with anyone, including her husband, whom she considers as the cause of her problem. She feels to be in permanent contact with television, which she has long conversations with, until she decides, to get out of this enclosure, to resort to something which does not belong to medicine (which, indeed, she feels remote from her): she appeals to a magician, whom she has come to know through a television program and whom she believes she can trust. Allegedly, he is an expert in occultism and, during his programme, he describes his powers that, supposedly, allow exploring the most tortuous and secret paths to get to the origin of evil. Antonia has felt his “fluid” over the air, something which has fascinated her. She feels him close to herself and, especially, she is confident that he can really help her. Once consulted, the magician accepts to help her against payment of a sizeable sum of money. The magician immediately pictures Antonia‟s disorder by giving a concrete description of it, identifies the spirits involved, and promises her that everything will be all right. But the spirits come back and the crisis too. In short, after a while, all is exactly as it was before. Hospitalizations, the psychiatrist, the occultist are all powerless before evil! But what is the nature of these spirits? Also the priest rushes to her sick-bed, called for as the last resort, out of complete desperation and agony. The priest enigmatically makes his diagnosis, hinting at “something weird, non-ordinary and altogether not good”, and, after beating about the bush for quite a while, suggests that the origin of the problem is the devil. He advises, as the only possible cure, resorting to an exorcist authorized by the Church (a religious diagnosis could only be matched by a religious de Martino provided some indications and drew up a sort of “map” useful to get into the territory of magic. Evidently enough, a map is not, by itself, the territory it describes. The researcher was always aware that his map – which, in short, consisted in saying the formula: “this is the magical world” – was nothing else than a logical abstraction marking the distance between the observer and the object, (i.e. “the magic”), the full comprehension of which could only be achieved by being immersed in it. However, the map is a good starting point, the benefits of which cannot be fully enjoyed unless one keeps in mind that the operation being performed is actually an abstraction. Only if we reach this awareness, can we listen to and read through this process, which is, in short, an involving observation which de Martino undeniably laid the foundation of. For a closer examination of this matter, see: de Martino, E. (2005). The Land of Remorse: A Study of Southern Italian Tarantism. Trans. D. L. Zinn. London: Free Association Books (originally published as: (1961). La terra del rimorso. Milan: Il Saggiatore).

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therapy!). Archbishop Milingo150 is mentioned, but, in order to see the (maybe too much!) celebrated exorcist, it is necessary to record one‟s name in a long waiting list and travel outside Rome. What about finding one in the suburbs? In the end, Father G. is found. It is to be noted that the number of authorized exorcists is increasing. The Church is actually taking emergency measures, not only to meet a growing demand, but also not to miss the opportunity to directly manage a kind of crisis which, in the final analysis, is one of many forms of the “crisis of presence”. Antonia agrees to meet Father G. whom – as she tells me in a subsequent encounter which she defines as “a check-up session and that‟s all”, – she greatly benefits from, because she “has finally found someone who has alleviated her suffering”. She no longer feels oppressed by extraordinary forces. The crisis has revealed her own psychic frailty, and, especially, has encouraged her to look for help outside traditional psychiatry. Let us dwell on another story. 28-year-old Gesuina is a practising Catholic who migrated to Rome on her own. She started feeling “possessed by obscure forces” when she got married to a man from the region of Abruzzi, whom she met in Rome, at the cleaning service concern she works for. Although conscious of their hostility, Gesuina lives with his husband‟s family. Her husband reproaches her for not being able to have children. She greatly misses her village and her family of origin, to whom she was and still is very close. With some effort (it is a sort of secret) I learn that, when she was younger, she suffered from an undefined “nervous breakdown”.151 The presence of this “spirit”, initially in the form of increasingly painful stomach aches, and later as real “blocks”, gradually makes her lose all sort of control, until she finally looses her identity. The crisis manifests itself in different manners: Gesuina lives through different experiences of epiphany, often with evil entities, sometimes with benign ones who want to help her (these can be likened to the tutelary geniuses of the magical word). As a believer, “made to God‟s image”, she refuses all kind of help, including her confessor‟s and the physicians‟: maybe she expects help from someone else (her husband, with whom she has very violent rows). Once the priest, a “family friend”, witnessed a bad crisis with piercing screams and aggressive behaviours. On that occasion he suggested that that was the devil‟s 150

In 2005 Zambian archbishop Emmanuel Milingo lived in Zagarolo, a village 60 kilometers away from Rome. He showed to the public on Tuesdays and Thursdays, when he celebrated a Holy Mass “with healing prayers”, as the nuns of the order he founded specified, not to arouse false expectations among the many believers gathered. For other needs, including the “rite of exorcism”, it was necessary to be given a private appointment during which the appeal would be examined. Considering Milingo‟s many engagements, it was not easy to see him privately. Private meetings were actually discouraged, in order not to increase the number of unusual requests and also because the spreading of evil spells was a controversial issue within the Catholic Church. Recently, a new text on exorcism has been published by the Church (Rite of Exorcism, which replaces and revises the text of 1644), arousing polemics among those who support the older version. According to Father Amorth, the most important Catholic exorcist in Italy, the demand for exorcist practices is rising steadily, although there is a general reluctance to recognize this. Father Balducci holds an opposite view, according to which most cases are psychiatric problems, rather than demonic. In this regard, a recent initiative is worth mentioning: in February 2005, at the Regina Apostolorum pontifical university (in Rome), the first university course on exorcism was set up, reserved to priests and seminarians. The latest news about Milingo (2007) are that he left Italy, remarried Korean Maria Sung – whom he had married once, in a mass wedding celebrated by reverend Moon (considered by the Catholic Church as the leader of a sect) – and continues to support his cause in favour of marriage for Catholic priests. In 2006 he ordained four priests who, under the canon 1382 of the Code of Canon Law, incurred, with Milingo himself, a Latæ Sententiæ excommunication (i.e. for having accomplished the act). The name of Emmanuel Milingo has been removed from the Pontifical Yearbook: the thick red book which illustrates, year after year, the state of the Catholic Church all over the world, no longer lists the excommunicated archbishop. In October 2007, the Vatican City State revoked his passport, thanks to which, up to then, Milingo had been able to travel with the diplomatic protection from Vatican City (thus enjoying a full diplomatic immunity). 151 Common definition of a psychic disorder.

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work and advised that she be taken to see an exorcist. This suggestion fell on stony ground because of Gesuina‟s refusal. Since that crisis, confronted with increasingly recurrent ones, her relatives have resorted to the emergency medical service, which has meant that her problem has been dealt with by means of continual hospitalizations. After the umpteenth hospitalization – justified by supposed psychomotor agitations, with ideas of persecution – they have turned to the service where I work. First my team and I have a talk with Gesuina‟s husband, more and more scared and discouraged, who ends up admitting that he does not want to take her back. We convince him to make another attempt by taking, with our help, a different, altogether new, path, and we illustrate our therapeutic plan to him. According to this plan, in order to better understand the situation, we shall meet the extended family at their home – once Gesuina has left the hospital – following a well-defined schedule of visits. The goal is interrupting the never-ending cycle of hospitalizations and also giving an opportunity for reflection to try and understand what is really happening. Initial observations. We realized that, to reach this outcome (a truce between belligerents), a change in mutual relations and the way of viewing each other was necessary, also considering that their respective cultures were different (the only feelings they had in common, i.e. mistrust and uncommunicativeness, increasingly worsened their conflict). Also their horizons differed (Gesuina‟s parents-in-law were looking for “a place” where to take her, while Gesuina sent messages no one heard). Initially, the therapeutic team's work was very much one of cultural mediation. We immediately realized that the clash of “cultural worlds” (the concept of marriage, the running of the house, the projects of the family group, and so forth) was actually a conflict between the ways in which these worlds manifested themselves and the persons involved. The more religion and, especially, evil forces were mentioned, the more a conflict among the family members and inside each of them arose and worsened, as a dramatically and sadly human conflict. We attempted, all together, to take a new direction towards change. During our encounters (all at Gesuina's, even if this entailed some organizational difficulties for us) we always sought to establish a direct communication, by inviting them to make explicit their opinions and expectations, for too long unexpressed. The idea was creating the conditions necessary to say the “unsaid”, which was a particularly heavy burden (such as the blame for not being able to bear children and the prejudices against the “islander”, viewed as someone who had found, in her husband, a “good match”). In her turn, Gesuina said that she had always felt judged and never really understood and that an evil force had stolen her marriage from her, by possessing her. Subsequent observations. Jaspers (1986) clearly describes the experience of those who suffer from this kind of disorder, observing that the individual “has the experience of being two persons at the same time and two heterogeneous modes of feeling occur along with the presence of the two selves”. This is a condition characterized by dichotomies – good-bad, mind-body, sacred-profane – which are lived in a harrowing way. The impact of a crisis of possession – which generates great anxiety in everyone and, especially, a state of confusion that does not let differences come to the surface – calls for intervention. But, first of all, an intervention on what or whom? The observations on the “being acted by” issue are to be put into a psychopathological perspective which is, ipso facto, inexhaustive, and – nonetheless – open to the “interpretations” of other disciplines (anthropology, history of religions, relational psychology, and so on). Concerning Gesuina, seemingly she was affected by a possession syndrome. Typically, the image of one‟s self, connected to the usual development processes of one‟s cognitive and existential lived experiences, is split, as if there were another self,

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extraneous and imaginary, who has slipped in and whom the patient feels dominated, or acted, by. Hence the tendency to give shape and physicality to presences which are inside oneself. Evil controls one‟s actions and movements. Gesuina‟s mind became increasingly rigid, focused on single-themed and unilateral thoughts, absolutely unable to enter into a dialectical and mutual communication with others. She even sought, through a process of personification, to blame others for the negative and undesirable aspects of her character. Her suffering might have been aimed to protect the couple from their convictions, laying the blame outside. In her cosmogony, where there existed protecting elements of a magical kind, ambivalent emotional configurations had taken control of her mind: thus, Gesuina alternated between distress and the need to be reassured, unable/unwilling to develop other opportunities for choice in the context where she lived. The origin of the disorders affecting her may be found in an original cosmogony, that of the magical world, which had dangerously become her only horizon, a dimension inhabited by good and evil spirits – the two categories stemming from deeply-rooted, though mostly unconscious, beliefs – where she lived, trapped in an endless conflict. But, as has been noted, such a conflict was fuelled by her difficulty in asking for help. Turning for help to whom? To religion? To psychiatry? Maybe both, ipso facto, forced this woman to make one choice: rejecting her shadows, whether good or bad, that inhabited her magical world and were so alive to her. Such experiences, made at the individual’s level, cannot be taken into consideration outside the cultural and family system where they are lived through and the code of meaning they take on within specific family dynamics (the couple‟s symmetric social growth, the ever-present and strict families of origin who prevented their respective children from reaching emancipation, the lack of boundaries between the couple and their extended family, and so on). These issues, both pertaining to the individual and the family, are often surrounded by a tragic and inexplicable halo, which hinders the work of the clinician who, at first, wishes to observe and know the situation in order to choose the most appropriate intervention. If understanding the nature of the symptom in an extended context is important, it is equally essential to reconstruct the image of the patient‟s self, torn to pieces and shattered. Therefore, the work shall proceed on two levels: the individual and the family. Final observations. Gesuina‟s disorders can only be observed within an environment permeated with mythologies and beliefs which are very difficult to be put in question. For this reason, it is more reassuring for everyone (the patient included) to believe that she is controlled by dark forces, whether these are identified with the devil or with other phenomena difficult to understand. Interestingly, in our everyday practice, when we are faced with an obscure disorder, we often tend to look for causes, rather than focus our attention on the morbid process itself, which, before being explained, has to be “listened to” and “read” in a psychopathological perspective, not exclusively oriented into a diagnostic direction, that, in any case, would point to the identification of a psychotic problem. It would then be necessary to add further considerations about the “being acted by” issue, which cannot be done, as we have seen, unless the cultural and family system where these phenomena arise is taken into consideration. It is essential for workers to understand how that particular phenomenon has emerged and what role it plays in activating the group‟s dynamics (and this, sometimes, in spite of the tragic and inexplicable halo that often requires an immediate intervention). At this point, I shall underline that the whole therapeutic process is based on the ability to create particular moments, through which a new space-time dimension can be defined, a region where things can be looked at in a new way and worlds different from one‟s own can be

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approached. The goal is creating new frameworks where single events can be situated and then the conditions can be established for the emergence of the self, whose image, in pathological phenomenology, appears greatly fragmented and confused. It‟s not in the least less important to discuss these issues also in the context of the complex and age-old debate revolving around the following question: “Does possession fall within the competence of the Church or psychiatry?” (the answer to which is actually more useful to emphasize the vague boundaries separating the two areas than to provide a solution). What message do these stories convey in our times, at the beginning of the third millennium? Wonder, amazement? A stubborn resistance to the irrational which eventually makes us label them as events of “ordinary madness”? The scenario where these phenomena arise is often the urban one, notably suburbs with a high concentration of immigrants, areas swarming with people and, especially, a large host of beliefs, myths, and world views which protect and disquiet at the same time. It is not in the least paradoxical that in a completely technical society there exist life styles which are related to an atavistic universe inhabited by superior entities who are feared because they are uncontrolled. Such a fact tells us about the limits of our skills and knowledge. Taking into account the conditions of a patient, suffering because of an evident tearing of his self, is not enough. Other considerations are required. We are confronted with a horizon of crisis with “atavistic” aspects, in the background, as well as “contemporary” aspects, which determine a life always lived in precariousness and in need of protection. The observations made on the family system, the way the relationships among the family members work, and the cultural system – that is, the system containing the family one – can certainly be a valuable source to postulate other theories. Yet, a systems approach to such phenomena would require that we ask ourselves what equilibrium is created around these magical symptoms which often hide and protect a wide network of interpersonal relations lived as a conflict. Under these circumstances, a family system becomes at once stiff and fragile, just as glass, likelier to break under external pressure. Nor can we overlook the fact that the system itself, once it has acquired its own peculiar and paradoxical structure, can hardly accept a complete change such as the one that a therapeutic strategy involving all the family would require. That is why “obscure forces” are so hard to chase away. Indeed, first we should understand “who needs them” and “whom they want to protect from whom”. In other words, the existence of these demons is not to be considered as a symptom per se – as the detached clinician‟s eye would do – but in terms of its function, a task unconsciously charged to demons, that of keeping the family ties intact. Often, the way patients perceive their reality underlies their lived experience, worsening perception disorders which perfectly fit into the framework of the “crisis of presence” investigated, as we have seen, by de Martino. (Apart from the pathologies discussed herein, this crisis could derive its topicality from the uncertainty of our times, when we are more and more dependent on economic insecurity, social malaise, and disorders affecting our identity. To more sensitive people, these disorders can appear phenomena linked to world views of a magical nature which they feel they can resort to in order to get protection.) As I pointed out at the beginning, if having the “map”, i.e. saying “this is the magical world”, is not enough to get into the magical territory, the possessed patient will convey the message about his suffering in a distorted way. Actually, grasping the map/territory, real/magical relations, so as to take a more appropriate approach in the face of a symptom, is not a simple task. In reality, as therapists and researchers, – in spite of the openness of mind that some of us force themselves to adopt – we are only unprepared observers of what happens before our eyes, who strongly feel the need to

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decontextualize the psychic problem which we are called to deal with. As a matter of fact, we tend to overlook all the elements that belong to the magical and religious world and that, therefore, “are guilty” of not fitting into our mindset. Moreover, religion protects itself from observation, by enveloping phenomena in sacredness, a dimension forbidden to the clinician‟s eye. Hence our difficulty to make order in this scenario and get a more accurate understanding. Such a difficulty, however, does not lessen the need for suppressing, in the patient‟s interest, the dichotomy represented by the sacred, nested in possession, and the profane, belonging to the clinical field, by bringing them together into the human dimension, one that contains both. It is to be noted, however, that the land of the sacred is definitely wild and dangerous because it is exposed to the perils of misinterpretation and the slipping towards uncontrollable drifts.

Chapter 4

THE SERVICES PROVIDED BY MENTAL HEALTH CENTRES AS CULTURAL EXTENSIONS INTO THE TERRITORY 4.1. THE PLACE OF CARE What is a mental health service in the third millennium? What does it stand for? How should it be organized? What kind of reception does it provide to new clients? Does its function only concern care? Or assistance? And what kind of care should it administer? What does care mean? Or rather, what is the thinking that guides care? These questions open a window onto worlds, methods and issues which apparently go far beyond the mission of a mental health service. And yet, these worlds, methods and issues are a quintessence of it, an amalgam where they are all mixed together, from which – in the name of a neutral and detached service – we therapists defend ourselves, offering only our role and the facilities available, perhaps because we fear to lose our identity. Yet, the reality which is taking shape in our society clashes with the aforementioned mechanisms and it would be advisable to be ready to combine institutional tasks and the most varied modes of intervention. Is it really unrealistic to define a new use for scientific paradigms – which are often the exclusive property of schools and universities – to challenge bureaucratic arguments and too strict parameters for intervention, to look for nuances and light and shade where data and quantitative analyses prevail? Now I shall go back to my initial reflections. We need to keep in mind that, apart from being a multi-faceted place of care, a mental health service is also a place of observation. My studies of other cultural contexts and my experiences in nonwestern countries (Ancora 1996, 2006) have revealed the great importance of the place where treatment is administered, not only in physical terms. The place of care is also a cultural extension into the territory, which has rooted in the ground of the needs of those people who feel it physically close. Besides, it is an extraordinary opportunity for accepting suffering and reconnecting the broken parts of stories often lived in a fragmented way. Though it is true that it is essentially a therapeutic centre, still, during everyday work, it has to engage in other activities, which complement the therapy itself and give it a multipurpose and versatile role. Maybe someone still wishes that the service were untainted and more loyal to its strictly institutional role, purified from all “contamination”. But, when it gets into the real world, both social and cultural, this place cannot remain uncontaminated. Moreover, although it is charged with clear-cut tasks, it is constantly in contact with disorder and confusion, which

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give the idea of a “construction site” with workers who are not always “clean”. Indeed, on their dirty hands and faces there often remain traces of the materials they get into contact with. In this sense, it is a “structurally” transcultural place. If we look elsewhere, we shall learn from shamans, traditional healers and “other” workers how important it is to be “close” in the face of psychological difficulties, to answer a call for help and understand what intervention is required. A mental health service is, accordingly, (always keeping in mind the meaning of mental and health) a place of treatment which takes care. I shall now illustrate the reason why a mental health service is also to be considered as a therapeutic and cultural service. The first reason lies in the varied universe of symbols, representations, signs, and shades which all symptom contains and which can be grasped only in a place open to all this. Can‟t every mental health worker be likened to an ethnologist – as Devereux (1970, p. 12) and Resnik152 maintained – when he is about to know a phenomenon, other than himself, “in the field”, often burdened with his prejudices and ethnic-, psychiatry- or family-centred drifts? Whenever help is asked from a geographically relevant health mental service (the network of these services replace old mental hospitals, veritable depersonalizing and dehistoricizing places, remote from any chance of reconnecting pieces and parts of neglected personal stories), doesn‟t this call also express the need for closeness (not only material and physical)? Doesn‟t it show a desire to be welcomed and, only afterwards, be taken care of? Doesn't it provide the opportunity for expressing the sensations and the aspirations contained in one‟s heritage, shaped in the country of origin and carried along the disrupting and fragmented streets of our towns? Isn‟t this a cultural encounter-clash between the clinician‟s and the patient‟s worlds, where the patient‟s “tormented”153 story needs to be updated, even re-written, in view of increasingly stiff roles, detrimental to the scope for action and the closeness necessary to create new narrative plots? Isn‟t a real cultural revolution the one that was started in 1978, with the passing of the Basaglia law, and marked the transition from a “closed place”, such as the mental hospital was, to a territorially-based place of care, that is, one closer to the needs of suffering people? Finally, isn‟t of a cultural nature the challenge that territorially- and hospital-based services are to meet to strengthen their own identity, which is still young and thus exposed to difficulties, and to get ready to help new categories of patients: immigrants, displaced persons, refugees of all sorts, women who are victims of human trafficking, tortured persons, and people coming from the marginal world of the socalled “subculture”, by now a real “boundary pathology”? This place can become a breeding ground, a laboratory where ideas, persons, sensations, and suffering come together and multifaceted needs have to be met, redefined, lessened. It is important that clients view this place as something close, open, and accessible, even if under certain conditions. However, it may also happen that their imagination and expectations make them consider it as something boundless, almighty, where any problem can be solved. What is fundamental is that, at least, a client never regards it as something alien, but as close as possible to his own culture, his way of suffering, and his own representation of his disorder. The aforesaid observations are useful to reflect on the role of reference persons for the clients of mental health services, notably, nurses and social workers. The role they are called on to play is fundamental: they are real cultural mediators. This definition emphasizes the 152 153

Resnik, S. (1999). Personne et psychose: études sur le langage du corps. Paris: Éditions du Hublot. Shorter, E. (1991; first printed: 1985). Doctors and Their Patients: A Social History. Brunswick, NJ: Transaction Publishers.

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need for building bridges, which is necessary to understand and come to know the clients‟ languages, their world views, their neighbours, their meeting places, their places of worship, the bus stops where they gather, and “virtual” meeting places, that is, those they should have, but often lack in suburbs. Making contact with these places, some of which are more similar to “non-places”154, can be fundamental once an intervention or a project has been decided upon. The territorially-based service can, then, take on the appearance of a “quite particular” physical and mental place, almost strategic in the framework of therapy (the Greek word means “service”) and also of prevention of psychic disorders. It can be what at the beginning I termed a “cultural extension” into the territory, which takes root among needs, even though demanding organizational requirements often set limits impossible to get over. Whatever the intervention possibilities, I wish to emphasize a concept which I have mentioned earlier on: the territory before us has to be explored, fully known, and its internal differences are to be clearly identified. Indeed there exist rules and habits which differ between a town and another155, a “more central” and a more peripheral culture – sometimes within the same district –, two buildings, and reunited families and the ones of origin. This analysis/proposal, which is not necessarily one to agree on, may nonetheless help to better understand why we often fail to deliver an efficient intervention and why our intervention sometimes is nothing else than the release of a certification/notification or the simple control of unfortunately chronic conditions, accompanied by no prevention in mental health. Moreover, certain socioeconomic situations – thought to have disappeared long since – which were breeding grounds for psychic diseases156 have re-emerged, especially in the suburbs of cities. That is why, social and cultural issues – if ever reassessed to the benefit of biological-molecular hypotheses (whose advancements are nonetheless to be taken into account) – have recently acquired a great relevance, not only in psychopathological terms, but also in the framework of the evolution of any therapeutic project. Connecting what is done, how it is done and how it is thought about is very urgent. The trammels of bureaucracy that encumber public services do not often allow for a wide scope for action or reflection, also considering the continual fund cuts, which endanger any working hypothesis based on professional competence, passion and planning. At this point the following question – though partly redundant – has to be asked: “Is a better balance between interventions and the real availability of resources possible?” Besides, the World Health Organization has declared that mental diseases, in all their aspects, are the most costly to society. The aforementioned observations, obviously very limited and incomplete, stem from the work which the service where I work carry out each day, among difficulties and in silence, a work which at times appear precarious and ungrateful, as well as completely isolated from the territorial network.

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Augé, M. (1995). Non-Places: Introduction to an Anthropology of Supermodernity. Trans. J. Howe. London; New York: Verso. (Originally published as: (1992). Non-lieux. Paris: Éditions du Seuil.) 155 On urban psychology and its connections with subcultures, see: Hebdige, D. (1979). Subculture: The Meaning of Style. London: Methuen and Co. 156 See the following two books which, though “forgotten”, are still very topical: Hollingshead, A. B. and Redlich, F. C. (1958). Social Class and Mental Illness: A Community Study. New York: John Wiley and Sons, an unrivalled study of social pathology and methodology, which focuses on the American society; Halbwachs, M. (1959). The Psychology of Social Class. Trans. C. Delavenay. New York: Free Press (originally published as: (1938). Esquisse d'une psychologie des classes sociales. Paris: Librairie Marcel Rivière et Cie.), a thorough description of the collective representations that prevail within the various social classes.

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4.2. TRANSCULTURAL CONSULTATION AND ITALIAN FAMILIES Before moving on to the description of specific cases of some Italian families, I deem it appropriate to make some more general considerations on the families who turn to the mental health service where I work. The malaise they report to workers and the service (at times in a confused way, to dismiss the real problem) needs to undergo a redefining phase, which is often long and tiring. This phase is necessary to shape a therapeutic context, save in cases of crisis where immediate observation can be helpful ipso facto. The most significant sequences that I shall dwell on aim to highlight what happens most frequently, notably the mingling of cultural and therapeutic elements. These two kinds of elements are interconnected. Indeed, in certain cases, a change is impossible unless a change occurs in the way “we think of” certain events, world views, and values. Now I shall examine some features common to families157 who live in the suburbs of Rome, where they have migrated on their own, and are permeated with myths inherited, created, shared, and finally passed on the next generations with no additions. These myths affect visible relations among family members and also imbue the air they breathe, by filling it with much of the “unsaid” and the “implicit” which the life of the whole family system is based on. It is to be noted that this system is an extended one, which also includes the people living in the flats served by the same common staircase.158 These are urban areas where the unauthorized construction of buildings was once the rule, rather than the exception. Stone after stone (in this case, the literal and the metaphorical meanings completely overlap) whole buildings were erected: car boxes first, then the first floor, then the second, and so on. During this time, all the family members, the youngest included, participated in this feverish and zealous erection of walls, spurred by the promise that everybody would one day get his “part”. Over the time, this ideology based on making has created relations, myths, and emotions, all within the constraint of upholding and preserving family unity at all costs. This is considered as an undying value, that no member of the family can dispute. Such a model determines a kind of interpersonal relationship that Wynne159 has termed “pseudomutuality”. This relationship could be likened to a locomotive to which carriages are attached, one after the other: woe betide anyone who is left apart, the risk being that of remaining on the platform, isolated, eventually unable to express one‟s ideas or becoming marginalized. Actually, following a different route is not even allowed, such is the depth of the feelings and the consensus which family unity has been built on. Culturally such a family system is often static, that is, blocked on a few simple concepts and based on a poor pattern of exchanges with the external world. During the first encounters the therapist realizes that the interactions at work are predictable and predetermined and that, accordingly, helping to make this rigid schemes 157

In this book the term “family” is used in its narrowest sense and does not refer to the different groups of people that are formed in today‟s society and that represent new forms of social organization (cohabiting couples, mixed couples, extended families, recomposed couples, etc.). Here this term is used in its most common and traditional sense. For a description of changes occurred in the Italian society, see: Zanatta, A. L. (1997). Le nuove famiglie. Bologna: Il Mulino; Fruggeri, L. (1998). Famiglie. Rome: Carocci. 158 It is common that all the people living in a single building are members of related families. 159 Wynne, L. C., Ryckoff, I., Day, J., and Hirsch, S. (1958). Pseudomutuality in the Family Relations of Schizophrenics. In Psychiatry (No. 21, pp. 205-220).

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flexible again is to be his first goal in the process of change. It may happen that one of the first encounters is precisely of a cultural kind. Indeed, the therapist often finds himself confronted with a family system that wants to show itself as concrete, matter-of-fact (“We have no time to lose!”), whereas his own culture is slow-paced, and he needs much time to observe, and long stretches of time where he can only find a few answers to many pressing and defying questions. Reverting to myths, which often keep the family united and unchanging, an interesting definition is given by Pettazzoni,160 a notable researcher in the history of religions: “Their truth has no origin in logic, nor is it of a historical kind; it is above all of a religious and, more specifically, a magical order.” Its meta-historical meaning puts myth above everyone and everything, and it‟s precisely in the name of myth and its non-verifiability and immutability that situations become rigid and unalterable. Often myth is viewed as so unshakeable and is made the object of such a deference – nearing devotion –, that any other need or movement is stifled. Freeing oneself from it is almost impossible; a “leap”, or rather a painful flight, would be necessary towards targets that, at least in the beginning, are not clear. But the journey into one‟s consciousness is very difficult and disease is not always lived as a first step of a beneficial “criticism” of one‟s too narrow view of the world and reality. Disease is not regarded as a possibility of emancipation and autonomy, but rather as a trap where one has fallen and from which it is difficult to free oneself, with no opportunity to take another route. These families often fail to see events from a different perspective precisely due to the cultural means they have. At first, the reaction to the disease is one of dismay and amazement. Then, the presenting problem undergoes a “particular historicization”, such as, for example: “He has always been weird, ever since he was a child. Of all his brothers and sisters he alone didn‟t like the trowel. He has always been a little weak, even if he was good at school.” Another aspect that makes the diseased withdraw into himself even further is the conviction that he has disappointed his family. He feels guilty for having undermined the structure of his family-building; he couldn‟t even lay one single stone!161 As a builder of therapeutic realities, the therapist shall have to start from these observations if he wants to try and make change happens. As already suggested, he has to take into account the possibility of a clash which is also cultural, because he will find before (or against) himself a family system that is homogeneous, coherent, united, and very determined to safeguard its own cultural identity. Although it is based on myths and narrowness, the cultural identity of the family system is always a precious support, something to be proud of, notably in an anonymous and depersonalized suburban context which gave the family a bad reception at the time of its migration. The therapist‟s request for collaboration from the family – that is, whether all of the family members or only those directly affected by the problem shall go to see him – is usually heeded only by the mother who is worried about her son and, yet, is reluctant to leave home and her household works (“Who will do the cooking?”): in a productive family not even a day of work can be missed. Thus, in their eyes, the best solution is that of “a place” where 160

Pettazzoni, R. (1967). Essays on the History of Religions. Trans. H. J. Rose. Leiden: E. J. Brill, p. 16 (originally published as: (1946). Saggi di storia delle religioni e di mitologia. Rome: Edizioni italiane). Cf: Boscolo, L. and Bertrando, P. (1993). The Times of Time: A New Perspective in Systemic Therapy and Consultation. Trans. S. Thorne. New York: W. W. Norton and Company, p. 70 (originally published as: (1993) I tempi del tempo. Una nuova prospettiva per la consulenza e la terapia sistemica. Turin: Bollati Boringhieri). 161 This is what the family “accuses” the patient of, according to its one-way view. At the same time, this is the greatest “help”, decidedly incomprehensible to the family, that the patient is giving it.

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the patient can stay because “home is not an appropriate place for him, who is in such a bad condition”. I have observed that in most cases the situation is as follows (avoiding generalization): both the ability and willingness to collaborate are insufficient. For the situation to loosen up it is necessary that interaction reach a deeper level, although the family‟s defensive attitude and often excessive resistance are to be taken into account. In this light, a possible access way is represented by a clear and direct language, which is also to be based on proverbs or figures of speech and idioms typical of the family‟s place of origin, thus recalling ancient wisdom! The therapist has to set himself small and concrete objectives in order to get closer to the family on a cultural level. To do this, he has to keep in mind that trust is the first step. Indeed, these rock-like and inscrutable appearances hide a certain (and age-old) mistrust – that integration problems have exacerbated over time – towards others or, in general, society, of which the therapist is a representative. The way of interacting which the family is culturally familiar with – exclusively based on the success of its achievements (the house, the land, and so forth) – can be “interrupted” by stressing even the slightest emotion that emerges in the therapeutic session. In such family systems there is no place for trifles and weakness, let alone the expression of feelings or all sort of affection, which have never been given room because “there is no time for this kind of things”. Clearly the members of a family group – often very large, i.e. an extended family – have not favoured the development of emotional manifestations because, by living in common, also in the adult age (even though on different floors of the same building), have not allowed the development of their autonomy nor the creation of private and distinct spaces, fundamental for a normal growth. In certain cases, I have developed veritable building community-targeted therapies, necessary to define – with difficulty, actually – those boundaries that house walls could not provide. Let me make yet a final consideration before passing on to the next descriptions: it would be a great advantage for the therapist to get information on the origins (also cultural) of a given family, whether Italian or not, as well as its habits, customs, and traditions. As a matter of fact, these elements are present in every therapeutic session, either as indecipherable and deep-rooted rituals or as invisible bonds that any cultural system or subsystem has in itself and supports and bolsters all along.

4.3. MARIO AND HIS FAMILY What follows is the description of a family system, with particular habits and religious values, within which the development of a subsystem, with its own modes of growth, not only spiritual, has been difficult. In reality, “values become true preferential communication channels” which can be the only ones available in certain pathological situations. Now I shall dwell on the relations which have been established between this cultural family system and its subsystem. Mario, aged 35, is the eldest child in a family of three sons. As a child he duly finished primary school. He took his compulsory school certificate [TN: in Italy, school is compulsory until the age of 13; primary school lasts 5 years, from 6 to 10] by attending evening classes at a later stage, an event that his parents related with much emphasis, as if it was them who had

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taken it. Mario‟s troubles, which emerged after his engagement to a girl broke off when he was about 20 years old, manifested themselves with states of distress which completely blocked him and prevented him from doing any work. His health problems aroused much concern in his family and his religious community, of which Adolfo, the second son, was the leader. They turned for help to a psychologist belonging to the community. She had talks with Mario, defined as “confidential”, which ended with no explanation on his part. Meanwhile, his involvement in the community steadily increased, not only from a spiritual, but also from a practical point of view: his brother constantly asked him to help him organize ceremonies and festivals of all kinds. Mario was busy also in his leisure time preparing leaflets, banners and everything else was necessary to celebrate all sorts of events. Later on, his two brothers got married and moved to two flats in the same building as their parents‟. Due to this new arrangement, everyday life became an uninterrupted sequence of events, each one of which – from a birthday party to a movie on TV or a pilgrimage – was lived through as the three families formed a single clan, regardless of the needs of each family group and its single members. Mario started feeling boxed in. He did participate in all events proposed by the community, but only not to displease his parents, also considering that there wasn‟t enough physical or mental space for him to act differently. Some time later, during a severe crisis of depression, Mario attempted suicide and, once back from the hospital, he turned to the service where I worked. The decision was taken to meet him with his whole family, but only his parents showed up, allegedly because his brothers were busy: “A day of work cannot be missed, my dear doctor!” Sessions highlighted that the patient felt oppressed by many loads, on many sides, and that his only way to interact with his family had been, up to then, a completely passive attitude. The burden was becoming too much for him and his latest crisis had showed that observing all the rules and seeking to meet his family‟s expectations had not been enough, and thus, “depression was the only way out”. In reality, a family patterned in such a way was based not only on the acceptance of certain religious principles – which, in any case, could not be questioned – but also on rituals belonging to a culture that Mario only endured, accepting which was an obligation that ruled out any possibility to express dissent “in a normal manner”. Such a family system – or rather a building-community system – was strengthened, confirmed and kept alive by the interactions among the specific subsystems embodied by the different groups (or flats), giving the impression of an indistinct whole, with – nonetheless – had very clear-cut rules to abide by. Sessions showed that communication was patterned on the idea of family, considered central and above individuals themselves: it was taken for granted that belonging to the same group meant having a key which opened all the doors. More specifically, it could be observed that Mario‟s parents, worried and determined to justify and protect their son – who was silent or answered in monosyllables at sessions –, wondered how he could be helped, what medicines could be given to him or whether a preventive hospitalization was required. The atmosphere, however, conveyed a different message than that of words, even though no one was actually able to express it. A sort of equilibrium had been reached within the community around Mario‟s problem: the inability to understand him was sorely trying the whole system which, however, suffered with him, and Mario, in his turn, kept the system together by not recovering. The question was: was it there the possibility, in such a family subsystem, itself a part of a cultural system made of beliefs and acts of faith, to express one‟s own creed and religious life, as the first step towards autonomy? Were there the conditions for building a subsystem with its own limits,

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boundaries and identity through an evolution process? All this meant constructing a therapeutic reality with Mario and his parents. This would have been possible only in steps, by identifying phases where Mario could start a cultural, religious and psychological differentiation, without ever feeling discouraged, and by creating the conditions necessary for him to express his own opinion, without resorting to ways of expression that would be too complicated or burdensome. The symptom was not only to be deciphered, but it had to be explained as the only way of living and existing in such a context! The religious issue no longer appeared to be the only or, rather, the most invisible one: communication and emotional difficulties were more and more evident. Indeed, such a family system made it really difficult to create cultural subsystems (that is, the opportunity to live religion in one‟s own way) or subsystems consisting in one‟s individual identity and the development of one‟s own resources as personal attributes – i.e. not exclusively based on one‟s belonging to the subsystem, which had become too heavy to share stricto sensu. At the beginning the therapeutic approach consisted in reinforcing all subsystems (in separate encounters with Mario and his parents) and illustrating all the options available for a pharmaceutical treatment (something useful to all: to alleviate Mario‟s distress and to reassure his parents). This strategy aimed to lay the foundation of a possible “big leap”. The opportunity arose when a spiritual retreat was planned for a given week-end. Mario succeeded in asserting his will: he said he would not participate. Instead, he would stay home on his own and on Sunday he would remember to go to the mass. It was a great blow, but the therapeutic support provided until then was clearly giving some results. A slow process was at work, with a few inevitable veers (which, however, are part of any process of change): Mario‟s parents required that drugs be increased and Mario seemed about to give up, fearing that his decision would displease them. However, the basis for expressing his religious creed and his identity in an autonomous manner was being laid. More generally, the therapeutic work aimed to enable all the family system to find a new steadiness, among shakes and fears of all kinds. In the following step Mario would attend, on his own, a youth centre, and start working. Then, he could start an individual psychotherapeutic treatment to support his personal growth and autonomy, barely outlined and, thus, extremely fragile. This “social” detachment could allow the family to live in a less conflicting way the “religious” one and Mario to approach them in a more “individual” and “less family-centred” manner.

4.4. LUIGI AND HIS FAMILY The family described below is characterized by interactions which seemingly are onethemed, that is, centred only on the relation with politics, a factor which combines and aggregates different dynamics and hides any other need and issue. In such a system, it is difficult for a part “to separate itself” without challenging some important psychological and emotional mechanisms that govern the whole. Consequently, the risk is that the psychic malaise be interpreted from a single point of view, that of an attack against and the demolition of the family‟s values and its cultural and political unity. Luigi, aged 34, has a compulsory school certificate (he started high school, but eventually dropped out because he couldn‟t make it). His parents are farmers; Francesco, his younger brother, is a street sweeper, is married and has two daughters; Graziella, their elder sister, is

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separated and has a son. Parents and children are all members of the same political party, save Luigi who rallies in a more extreme wing. The first disorders appeared while he was serving in his national service, in the form of psychomotor agitation. He was declared unfit and sent home where he stayed on his own for a long time. He started a treatment with a private psychiatrist who held the same political opinions as his family. He slowly resumed the attendance of meetings and rallies, following his father and his sister, but, in reality, each time he was dragged to them. He was not convinced. His disorders worsened: he couldn‟t express even the slightest criticism towards a family system whose raison d‟être was its political party, different from Luigi‟s. Life went on repeating itself day after day: at lunch they would exclusively discuss about politics. A new crisis arose, in the form of auditory processing disorders (he heard a voice say to him that he was not happy with him and that things would go bad). The psychiatrist who treated him decided on his hospitalization in a private centre with a contract with the NHS. Then, Graziella, Luigi‟s sister, applied to the service where I worked because her brother and his psychologist had agreed to stop sessions. Apparently Luigi had said he didn‟t feel understood and no one would give him an explanation for the voices he heard. During our meeting, she told that in her family they always talked freely of everything, but her decision to separate from her husband had not been welcomed. She spontaneously talked about her brother whom she described as the most intelligent of the three children. She added that their relationship with him had always been difficult because of his more extreme political creed. Following a visit to the clinic, the agreement was taken to meet all together, after Luigi‟s dismissal. Luigi looks as if he were inarticulate. He is restrained by drugs and the grave atmosphere surrounding us. His parents claim to be ignorant and unable to understand what is happening to their son. Francesco, the other son, asks his sister, who seems to be the family‟s spokesperson, why he also had to come. To lessen the prevailing strain and graveness they start talking about politics. Everyone has something to say, save Luigi who emits a few monosyllables and only when he feels provoked. I realized that they related themselves to politics in an almost liturgical manner: demonstrations, meetings, preparations for the elections, the active distribution of the party‟s paper were all experiences they always lived through together and with the deepest personal involvement. Luigi followed them at all times, although this required of him an increasing effort. The culture they belonged to, passed on along the generations, was based on a fundamental principle: first, the Party (the capital initial is necessary to show how highly regarded the party was!), then, all the rest. In the following sessions I came to know that Luigi had never received much tenderness or endearments from his parents because life on the farm hadn‟t left too much room for “dialogue”, a word completely unknown to them, who could only focus their energy on keeping things going with three children to raise. Luigi‟s political creed was considered by the rest of the family as a sort of prank. Indeed, “he has always followed us in the end…” and “he would have told us if he hadn‟t agreed with us”. The sessions with the family were all repeats of the same one, where it could be sensed that they genuinely wished to talk and express their opinions, but, eventually, they only could express themselves through slogans and proclamations. Consequently only words went through. Emotions were left behind as was all attempt – albeit timid – to talk about oneself. Accordingly, the decision was taken to let the old parents rest (they came from far away) and to meet the three children, separately, to allow more significant information to emerge from their subsystem.

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Indeed, with their father and mother hen away, the three “big chicks” felt free to talk more openly. They expressed their regret for an affection and a personal space they had never had and added, in a protective way, that obviously it was nobody‟s fault. At home, there had always been much talking, but only about others and other realities, something that necessarily had to be nobler and loftier, i.e. ideals and values belonging to others, as if the family group weren‟t but a container of ideas coming from somewhere high above, which, as an eternal flame, had to be fuelled as best as possible, to pass it on the younger generations (not them obviously!). This conservative aspect of a militant culture had always been a hallmark of the family members‟ way to interact with one another, leaving problems aside – which they regarded as something negligible or very specific – in the name of high and universal principles. By separating from her husband, a “Controlled Origin militant”, as she had mockingly nicknamed him, Graziella had attempted to change this situation (that she herself defined “a bit heavy”). Instead, Luigi had joined the others, choosing a more painful and less explicit way to express his own diversity, which they saw as a signal of a multifaceted and increasingly deeper malaise. Following Graziella who, while talking about herself, was actually illustrating her family story, with quite understandable emotions, Luigi eventually succeeded in claiming that his political ideas were incompatible with his family‟s and that he had never been able to express them because they were rejected and were not along the lines of the Party. Maybe, at this point, an intervention was necessary to press for Luigi‟s brother and sister‟s help in order to make him regain his enthusiasm and the desire to participate in events that reflected his own beliefs rather than the family‟s. It was clear that this step would be possible only by developing a greater solidarity among the children, too many times granted in words, but never actually manifested. After this step, a more individual path could be chosen, one that would not only concern political divergence (already at work). What was being started, although with understandable fears, was a process that would allow each family member to acquire more self-confidence and, thus, be able to express freely “his/her own idea”. During the next sessions, extended to all the family, I required that the seventh member, invisible, but always present at the sessions (the Party), be kept aside, to see what would happen. Obviously this affected everybody‟s way of interacting: indeed the way of interaction to which they were used showed to be inconvenient to all of them. The “three chicks” were the ones who suffered the most because they felt free to criticize and complain only when their parents were not there, whereas, in their presence, they preferred to nod, and share their culture and, apparently, their world view. However, it was clear that things would not be easy for Luigi‟s parents, either, because they were more and more convinced that there was always some room under their wings and that only together could they march towards new goals and new political manifestations. In reality, it looked as if they all started to feel naked and defenceless. The first one to express this sudden temperature change was Luigi who, afraid, said that, at the next session, he would rather be alone, without either his parents or his brother and sister who “controlled his drugs”! Maybe the definition of our objectives had been too rapid: Luigi‟s fear had to be reassessed and strategies, too dangerous, needed to be rethought. I agreed with Luigi to start a series of individual sessions with him, with the aim to further strengthen him since, evidently, the path had showed to be bumpier than expected. The general goal remained that of succeeding in talking freely, about oneself and the others, without the protection of the

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family, with the possibility to express dissent and, in future, specifically for Luigi, to take different and alternative routes, not only political. We were all aware that it wouldn‟t be easy to learn to relate to one another by looking more deeply into ourselves, passing from a wordbased culture to a more emotional one, and paying more attention to the other‟s words, eye expression and gestures. It would certainly be a great change that would first arouse some crises and then new and unpredictable situations. How frightened we all were! It was necessary to start exploring those areas of mutual sharing and intimacy, not only political, which they hadn‟t had the chance (or the time) to recall and, especially, to tell about (also to oneself) by starting, for example, from that time when they hid away, fearing to be beaten by their parents for having stolen figs from their neighbour‟s tree, or that other time when they had been left at home alone and a storm had broken out… A difficult journey into the world of emotions had just – maybe – started!

4.5. MADDALENA AND HER FAMILY162 The following case highlights how, in a specific context (in this case, the peculiar region of Sardinia), socio-cultural matrices can turn into significant drifts of psychopathological processes. Moreover, it shows the different levels of the encounter/clash with the therapist‟s cultural world. Maddalena, aged 38, looked older than she was, also because she used to wear long skirts (showing that she belonged to an older generation). She lived in a village in Ogliastra, a centre-eastern area of Sardinia. She applied to the outpatient clinic where I was working at the time because she was suffering from a hand tremor due to a prolonged use of neuroleptics. She said she couldn‟t have her tremor examined because of the difficulty to travel to Nuoro, owing to a poor public transportation system and impassable roads163. Maddalena had three brothers, two were shepherds and one was disabled. In her childhood she was a bit different from the other children, so her parents said. She first showed her “weirdness” at the age of 15, when she heard “strange voices”, bad voices which told her to do ill. Following a severe crisis, she was taken to the hospital. After her dismissal, these dysperceptive phenomena were still present, though mitigated. Her parents, who were Catholic, said they had tried everything: they even took her to the “Mes‟austu” festival (“mid-August”, that is, the feast of the Assumption of Mary, celebrated on 15 August) where they had her participate in the procession, walking before the statue of Mary, carried in some believers‟ arms. But all attempts had failed. She had gradually cut herself off, going out less and less often, until she finally gave up going to the mass. One day, at home, she went through a very severe crisis, with desperate yells and incoherent speech. But this time she couldn‟t be taken to the hospital because it was winter and the Correboi pass

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This clinical case is part of the work experience I made as a psychiatrist and a psychotherapist at the mental health service of Nuoro and the surrounding area. The region around Nuoro is particularly difficult to access and comprehend. There are many cultural, historical and geographical differences among the various areas which make up this region. One need only think of Barbagia, harsh and contradictory, Baronia, slow and complaisant, Planargia, with Bosa and the cultural heritage of Pisa, beautiful and decaying, Ogliastra, remote and complex, and so on. Recently the region has been territorially redefined.

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(in the mount Gennargentu), the only road to Nuoro, couldn‟t be used due to the heavy snowfalls which unfailingly, during this season, made it impassable. The family was helped to tackle this emergency by a cousin of them who worked as a nurse and who succeeded in getting everything necessary, since hospitalization was out of the question. This mobilization was really extraordinary: friends from the parish, distant cousins, strangers, even the pharmacist (also GP) were ready to help. Initial observations. What was happening? Was it just “chance” that in winter had unleashed energies with a power that was unthinkable in other times of the year, as if natural events had played a role in the interaction with all the other elements of this system or, more precisely, ecosystem? Or was it “necessity”, as Jacques Monod would have it164? A particular event was taking place in relation to which resources could apparently be activated “intermittently”: in winter they could, in summer they couldn‟t. Various hypotheses could be put forward to explain such event (that happened twice in two consecutive years, both times in winter), also in the light of the capacity/possibility to activate a network larger than the family group. The family was paralysed before the crisis that Maddalena went through, which perhaps “aimed to say something to someone close” (even though she didn‟t feel it that way); and all those people “from far”, whom she considered “good” (in contrast with her “bad voices”), would maybe give a different meaning to her disease. Besides, the family members regarded themselves as “so unlucky” that even nature – in this case, “malicious” – had showed to be against them by making hospitalization impossible, a measure that, to them, was the only means to help Maddalena. Might the family have developed an “animistic-like” relationship with the ecosystem and its unfavourable natural elements (tough winter and impassable roads)? The missed hospitalization fitted in the framework of a completely negative world view (the power of the negative, as de Martino would have it). Why couldn‟t they understand that nature was maybe coming to their help (even though they weren‟t aware of this)? Their world view – to be respected and taken into account – prevented them from realizing that the need to tackle emergency “in another way” could also be an opportunity to create some (inner) room for reflection, which meant recovering their self-confidence and being well-disposed towards others, thus upsetting their usual behaviour. In other words, this interpretation of facts could have given them the opportunity to change the way they had so far looked at things. Yet, making room for a different world view in a system which was organized in such a rigid way wouldn‟t be easy. I had to work with the prospect of helping them to create “other” horizons. Let us return to Maddalena. I proposed to the general practitioner – in his role of cultural mediator – to meet all the family members together. During the session what emerged was a way of communicating made of mistrust, poor conversation, scanty dialogues interspersed with eerie pauses, and a serious difficulty to interact. They appeared as if they were tightly wrapped up in a hard covering, which was extremely hard to break165. Maddalena

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Monod, J. (1971). Chance and Necessity. Trans. A. Wainhouse. New York: Alfred A. Knopf. (Originally published as: (1970). Le hasard et la nécessité. Paris: Éditions du Seuil.) Studies in this field confirm the presence of this particular pattern in certain families. In La famiglia esclusiva (Bari: Laterza, 1971), L. Pinna demonstrates that, in certain areas of Sardinia, the nuclear family is the only social structure where it is possible to meet all expectations of an individual at economic, collaborative, and emotional level: in short, all existential and social expectations are focused inside the family, which is completely closed to the outside world (that is always viewed with distrust and suspicion). In In nome della madre - Ipotesi sul matriarcato barbaricino (Milan: Feltrinelli, 1978), M. Pitzalis Acciaro describes the main features of one pillar of the Sardinian family, the mother. Although she is viewed as a secondary figure (the

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talked very little and, although our encounters – held on a monthly basis, due to economic as well as transportation problems – had a duration close to two hours, it was very difficult to interact with her. The same applied to the relatives who accompanied her: her father, her mother and one brother. Clearly their implicit thought was: “We are here just because the doctor told us”, that is, out of respect and deference for the GP. In other words, it was as if they thought: “We have to do it, even though we haven‟t yet understood why. This is the fourth time we are here. Why do we have to come all together if the ill one is Maddalena?” Once, however, attempts were successful and her father spoke his mind. He said that everything was all right with the family, that he feared God and that, as a shepherd, he was used to “feel” it when the air was not good, “in which case one must go back to the pen with all the goats and wait for the storm to end”. As to her daughter, he had given up understanding her; maybe she was obsessed with something – no one knew what or why – and it was better to keep her shut at home because, otherwise, she could get into trouble outside (it is to be noted that, as the family representative, Maddalena‟s father spoke employing the first person plural “we”). The others were completely silent, something that didn‟t change in the following sessions. However, whenever I observed Maddalena, I could note her tense and painful stare, a stare which was also slightly hopeful. Her eyes were the only ones that regularly looked into mine. The others completely ignored my stare and only looked at walls, tables, and chairs. Besides, Maddalena‟s mother and brother always looked towards the father. In his turn, the head of the family often asked his wife to confirm what he said, whereas his son nervously fidgeted with his “berritta” (hat), unable to decide whether to keep it on his knees or ask to hang it somewhere (which would have meant disobeying his father‟s “order” to be silent). In my turn, I sought to say something in order to ease an increasingly tense atmosphere. Stares and attitudes showed that another kind of communication was at work, even though it was neither perceived nor understood by anyone. The overwhelming silence was broken by a question I asked the parents, which was actually addressed to Maddalena: “This year, will you send Maddalena to the “Mes‟austu” festival?” Maddalena answered quickly: “I do not want to go, it‟s them who want to take me there.” – “Why don‟t you want to go?” – “Because the Virgin Mary does not love me any more.” – “Tell me more about it. It is important to me.” By producing a restraining effect, her father immediately broke in: “She always says so. But in the end she never fails coming. She asks to come herself. Don‟t you, Maddalena?” She nodded, unable to say what she really thought, feeling stuck. Then, I started to speak again employing a culturally different approach, more careful to acknowledge her father‟s authority, not to question it (or make it question), and asking his authorization to address Maddalena directly. “Answer the doctor”, he told her. Only then was it possible to start talking with her about the religious festivals she had participated in, the ones she would have liked to go to, the people who had helped her when she had been ill, some of whom she didn‟t even know. Something similar to a “cultural thaw” was slowly happening, that is, a greater openness, a greater readiness to listen to Maddalena while she talked “in normal conditions”. Everyone could rest assured that no one meant to infringe the family‟s cultural codes, world view, and conception of nature. Indeed, I realized that it was precisely by respecting them that it would be possible to set out the conditions to sign a real pact between the therapist and the leading one being the father), she is actually the guardian of all the secrets and rules that impact on, if not condition, the whole family‟s life.

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father. “In two weeks I'll travel to your area to see whether it is possible to use some premises of the local authorities to set up a mental health service. How about if, on that occasion, I visited your house? So, Efisio, you could show me your small pig-farm (which he had told me about in a previous session) and maybe also your goat pen. I could finally understand why the hams from your area are so good and small!” – “As to your last question, I will explain you right now: we prepare them by using the legs of pigs that eat natural food. We don‟t add any substance to their food to fatten them. They eat what they find in the wild state, and nothing else. If you honour me with a visit, I will be happy to show them to you.” Maddalena smiled when she heard about this proposal for an invitation and how it had been accepted. But she also realized that the game166 was just starting and that rules were still in the process of being defined… Subsequent observations. The difficulty to open up “towards the outside world” added to the mistrust that the family felt towards “the doctor” who used an approach completely unknown to them (my request that all participate in sessions, not only Maddalena; my insistence to rely on her slightly more than the others, aiming to gain her trust; the decision to give her a treatment based not only on drugs, etc.). The analysis of data (also those related to a meta-communication, such as silences, stares, and disqualifications) necessarily had to take into account the more general context where they emerged: the rural world. This world had to be respected and not judged by refraining from the use of any technique related to a “neo-colonialist” way of thinking. The therapist had to respect – “for real” and not “artificially” – the father‟s authority as well as the culture – albeit atavistic – that he embodied, which did not entail, at least at the beginning, the mother‟s involvement because he was the only representative of the family and, accordingly, the only one whom to address. As far as the ecosystem is concerned, the harshness and the cruelty of natural conditions, which made communication very difficult, seemed reflecting inside the family where relations were based on closeness, rigidity and fear. Actually, these features are often the outcome of “the tough work of living” in a hostile environment and in the face of the absolute precariousness of its horizons. Sometimes they make up the amalgam of which islanders themselves are made (not all of them, of course, and not in all the islands). Because of its cultural and geographical peculiarities, this part of Sardinia, in particular, looks more like an “island in a island”. External data (the natural environment) are also very important to attempt to understand their impact on the lived experiences of the individual and the family as well as their role in defining the relations among the family members and between them and the community from which they are used to defend themselves. In his turn, the therapist – once he has grasped (or merely perceived) the family system‟s cultural codes – shall proceed across and not above them.

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See: Selvini Palazzoli, M., Cirillo, S., Selvini, M., and Sorrentino, A. M. (1989). Family Games: General Models of Psychotic Processes in the Family. Trans. V. Kleiber. New York: W. W. Norton and Company (originally published as: (1988). I giochi psicotici nella famiglia. Milan: Raffaello Cortina).

Chapter 5

TRANSCULTURAL CONSULTATION AND FOREIGN FAMILIES – BETWEEN SAYING AND DOING: “CONTAMINATED THERAPIES” In Italy, a country from which more than 20 million people migrated in a century, there live about 2.5 million regular immigrants.167 As has already been noted, this phenomenon is transforming the Italian society which has not always showed to be ready to face it. The same applies to mental health workers who are often equipped with intellectual and technical means which are inadequate to deal with new kinds of patients. As far as the consultation of families coming from other countries is concerned, there are no specific methods for me to suggest (the approach remains one of a systems nature), but merely theoretical-clinical observations to share which I have developed during my encounters with such families. Concerning the cases described below, I have selected the most significant parts, with the view to render more immediately the continuity between all the different phases of each. It is evident that an “account” (in this case, the description of these clinical cases) can arouse criticism on the part of family therapy “purists”, as well as those who, always searching for innovations, have found in the narrative technique the latest epistemological-clinical “trend” and accordingly will not find here what they expect. The account is to me an attempt to create order and order patients‟ stories (and perhaps mine, too), even though at different and asymmetrical levels. Care is to be considered as a non-pure process as soon as it merges with reality and becomes permeable to all social and cultural, as well as other, influences. The phrase contaminated therapies shall be employed here to better encompass and comprehend (from the Latin word cum-prendere, to get together) all the elements – often regarded as external and irrelevant to care – which we have made contact with “in the field”. This direction can create a “contamination” which necessarily implies losing, at least in part, the methodological purity which often shows its inappropriateness before certain multifaceted and complex psychopathological phenomena. Contamination indicates, at once, a direction and a process with outlines that are often blurry, implying the fear to lose something… This process can also represent the metaphor of the “journey”, the transition “across” which the explorer/researcher/therapist can make, as has 167

In February 2009 a draft decree was put forward by the Italian government, led by Berlusconi, whereby illegal immigrants would become ineligible for medical care.

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already been illustrated. Consequently, it is necessary to risk more, to attempt to “dismember” oneself and then re-compose all one‟s parts, go across, come back, transform oneself and build a story together with the patient, as we are taught by Siberian shamans, veritable threshold men. Adapting to an “idea in motion” is nothing new to us; indeed, it is something that our society has definitely accustomed us to (we are all passing through). A “selfreflecting” pause is actually necessary to allow the suspension of our spatial/temporal categories or our conceptual or cultural paradigms and open routes not yet explored by our perception and observation systems. In this regard, Tonino Guerra, a writer and a scriptwriter of some of the best-ever Italian movies, describes the extent to which his way to look at reality has changed since working with a maestro such as Michelangelo Antonioni: “He taught me to create movement, not only by means of images, but also through depth.”168 Contamination169 is not a negative concept. Apart from “fusion”, it indicates something “which is not first-hand”, which has been in contact with other cultural or therapeutic systems. In other words, it describes a therapy based on contact, a term which, in its etymological sense, refers to the juxtaposition of two bodies – whether on all or only a part of their respective surfaces – or a relation, that is, a connection between two more or less direct conductors which enables the passage of current from one to the other. This concept necessarily relates to the invitation to “think transcultural” which I have been seeking to define so far, a systems approach that is, rather, a multi-systems one, not only centred on the family or the couple, or therapeutic stricto sensu (i.e. connected to a thought focused on a single therapeutic session). The objective is working on the family group, other systems or subsystems, and simultaneously thinking/working “elsewhere”. In our current historicalcultural context, marked by radical changes and transformations, as well as phenomena such as migration – which Jaspers (1986) compares to an earthquake – the family consultant has to get down from his high horse, made of an epistemology which is “well-known” and “pure”, and, with a flexible and adapting mind, build/come to know inter-subjective realities (both social and cultural). This means that we have to leave the “usual” place, the one normally used for therapy, to find ourselves “elsewhere” with “someone else”. Metaphorically speaking, it is as if we passed from a “lunch session”170 to an ethnic-ceremonial lunch or the “Eucharistic table”, where different peoples communicate through work and bread171. Actually, wasn‟t Gregory Bateson the one who laid the foundation of an epistemology for a new way to observe anthropological phenomena, outside the safe British university milieu, which, at the beginning, also caused him some failures (see his initial research in the Hebrides islands and his first journey to Papua New Guinea)? We certainly do not have to go too far to perform our research: the “object” is among us! It has become a “subject”, or rather a host of subjects, whose strike force we either demonise or underestimate (at least in Italy), as we fail 168

Excerpt from an interview published in the daily Il Corriere della sera, on 5 February 1999. See: Cortellazzo, M. and Zolli, P. (1979). Dizionario etimologico della lingua italiana. Vol. I. Bologna: Zanichelli. According to the two authors, this term, whose etymology is uncertain, might date back to the times of Terence, the Latin comedy writer who was accused by his contemporaries to contaminate, i.e. “corrupt”, the comedies he translated. I personally prefer the definition given by Giosuè Carducci (Nobel laureate in literature in 1906): “the composition of a literary work by merging two or more works” (Poesie, Milan: Rizzoli, 1979). In music, the example of jazz is maybe clearer, a s a musical genre which is the outcome of the work of blacks and Europeans. 170 Minuchin, S., Rosman, B. L., and Baker, L. (1978). Psychosomatic Families. Anorexia Nervosa in Context. Cambridge: Harvard University Press. 171 Bastide, R. (1972). The Sociology of Mental Disorder. Trans. J. McNeil. London: Routledge and Kegan Paul. (Originally published as: (1965). Sociologie des maladies mentales. Paris: Flammarion.) 169

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to create with them significant relational frames. Maybe the time is ripe to follow anthropologist Sperber‟s172 suggestions on the way ideas advance and spread and his advice that the rooms of family therapy be provided with wheels so that they can start going. The thinking/acting discussed by von Foerster173 (1987) can really be interconnected with the theory/practice/theory which for long has been at the heart of sterile (and so-called political) debates, reducing all to more or less interventionist practices. A schematic approach risks bridling the therapeutic system, by making it a system generating “chronicity”174, and, as such, unable to integrate new ways of organization. According to Bateson, family therapy is a direction/orientation and not an enclosure (Ancora 1997). Perhaps the definition of the preconditions for a contaminated therapy is in progress, preconditions that will enable the appearance of a therapist who is a real threshold man, a border man, and a builder of dialogic realities, a capacity witnessed in “other” workers, such as shamans and traditional healers. Contamination is a “place in motion” where disorder and evolution can stop looking gloweringly at each other. Whenever contamination is discussed, Mary Douglas and her brilliant intuition come to one‟s mind: to indicate contamination she uses the term “pollution”175, which fits in the frame of the dichotomy pureness/impurity, that every clear-cut social structure develops inside itself. More precisely, if the symbolic, religious and social systems created by a given culture during its evolution are not properly examined, it will be impossible to grasp the restraints necessary to separate the two territories (pure/impure) and, especially, assess the risks which anyone wishing to explore this ground shall meet. The concept of contamination does not only encompass the notion of uncleanness and impurity, but also, and especially, disorder. Dirt as such does not exist: it takes on this value in the observer‟s eyes. The ideas we have on disease – “dirt” par excellence – have nothing to do with our attitude towards cleanliness or our distancing ourselves from dirtiness, which, whatever our viewpoint, is always incompatible with our personal idea of order. Its elimination is not a negative operation, but an effort aimed to reorganize the environment. Reflecting on contamination also entails “analogically” transposing from the world of ethnoanthropological sciences concepts such as dirty/clean and pure/impure and relate them to other categories, like organization/disorganization, balance/imbalance, formal/informal, and continuous/discontinuous. As a consequence of this transposition, our observations shall 172

Sperber, D. (1985). On Anthropological Knowledge. Cambridge: Cambridge University Press. The author sustains that anthropology should extend its boundaries by recovering its philosophical traditions which go back to ancient times. In Explaining Culture. A Naturalistic Approach (Oxford: Blackwell, 1997), he provocatively describes the “epidemiological” mechanisms through which ideas spread, similarly to infectious processes. 173 von Foerster, H. (1981). Observing Systems: Selected Papers of Heinz von Foerster. Ed. F. Varela. Seaside, CA: Intersystems Publications. 174 I have borrowed this concept from Risso (he worked with Basaglia in the mental hospital of Trieste), who was among the first ones to deal with transcultural psychiatry in Italy and who introduced me to these issues. See: Risso, M. (1986), Misère, magie et psychothérapie (in Confinia psychiatrica, Vol. 14, No. 2); Risso, M. (1950), Sull‟ideologia della prevenzione secondaria in psichiatria (in Fogli di informazione, Vol. 50, pp. 246252). Risso defines as chronification an “active” process through which a patient or a particular situation is made chronic, no matter how long the process takes. In other words, it is a kind of attitude of the mind. See also: Risso, M. (1980). Psychiatric Institution, Medical Ideology and the Chronification of Disease (in Schweizer Archiv für Neurologie, Neurochirurgie und Psychiatrie = Archives suisses de neurologie, neurochirurgie et de psychiatrie, Vol. 126 (2), pp. 327-335). 175 “Pollution”. In International Encyclopedia of the Social Sciences. Chicago: Encyclopedia Britannica, Educational corp., 1968. Here this term is used for the first time in the sense of “ritual contamination”, which will be later employed by Douglas.

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necessarily focus on our attitude and our subsequent behaviour in relation to communication. In fact, we tend to react negatively to facts and issues that make us feel lost or confused because they clash with our usual categories of thought. To what Douglas maintained with her provocation, I wish to add that the definition of a territory across pureness/impurity represents a particular horizon. Within this interaction, made of interstices and continuity, expressed and unexpressed forms can emerge, as well as the fascination of an ambiguity which often is not perceived, and the merging of new drifts. Douglas also asserts that “if uncleanness is matter out of place we must approach it through order. Uncleanness or dirt is that which must not be included if a pattern is to be maintained.”176 This continuous alternation between the categories of the literal and the metaphorical can assist us in the “final” phase of the therapeutic intervention, which, started with clear and clean assumptions, albeit not pre-established, can “soil” during our encounters with the world of care. Such a path made of new realities, transformative and irregular, asymmetric and uneven, can have surprises in store. It can indeed mobilize resources and shape attitudes which are “clean” and decontaminated (i.e. that belong to a new order), even though this may happen only after “soiling our hands”, unbending, and giving up the idea of always, unfailingly being at the helm. The goal of hermeneutic understanding is letting what happens to determine its orientation rather than giving an orientation to what happens (Anderson and Goolishian 1992). In this perspective, we could find ourselves in a cultural and clinical space, a free and particular place, where we could break a rule, violate some prohibition, “shift our levels” (that is, move to levels different from the standard ones). When we build this space together with families we can attempt to make visible all the sensations or emotional states that many of them may have removed. Indeed, out of habit and constrained by cultural rules, they could have gotten used to communicate as if they had never had the time – and especially, the space – necessary to live through these experiences, or the possibility to realize the absence of such a space. The place of care becomes, thus, a new way – to make one‟s own – to express things which couldn‟t be expressed in other spaces, to “tell” one‟s story with a new punctuation and new frames. Bastide argues that, in the framework of a contamination, disharmonious and asymmetric elements – deprived of their negative meaning – can create new modes to test new points of contact, collusion and collision and to co-live distances, become more accessible than before.177 The French sociologist encourages us to observe more carefully the “impurities” that all therapeutic process involves and contains and that determine “a new zone, or „hermeneutic boundary‟, where the subject, his ill body and society or the therapist integrate, destroy or remove parts of themselves, roles, values, constructions and representations of their identities and social contexts”.178 According to Selvini Palazzoli,179 any therapeutic context is characterized by asymmetry, that is, all those discordant and disorganized modes of 176

Douglas, M. (1966). Purity and Danger: An Analysis of Concepts of Pollution and Taboo. London: Routledge and Kegan Paul, p. 40. 177 Bastide, R. (1972). The Sociology of Mental Disorder. Trans. J. McNeil. London: Routledge and Kegan Paul. (Originally published as: (1965). Sociologie des maladies mentales. Paris: Flammarion.) 178 Tognetti Bordogna, M. (1990). Medicina ufficiale e medicina alternativa: due modalità comunicative. In Pizzini, F. (ed.) Asimmetrie comunicative. Milan: Franco Angeli, p. 175. 179 Review by B. P. Kennedy, Aesthetics of Change, in E. Imber-Black (ed.), Family Process, No. 23 (2), 1984, pp. 280-282.

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realities which neither patients nor families are used to. To this effect, a “contaminated” context can become a space open to new opportunities to know, with continuous decontextualizations and recontextualizations. In order for this to happen, a more relaxed and more flexible mind is necessary, inside which more pauses and intervals and a sort of “suspension” of the theory are possible, to allow immersing oneself, “lighter”, into practice and interventions. “Listening in a room” may no longer be sufficient: it is necessary to “go out” and make contact with the complexity of reality, experience new ways of imagination and creativity, besides the rigour that an ethical “contrivance” of observation can provide us once again (on this point, Devereux‟s lesson is still unequalled). Epidemiological statistics show that a higher appreciation of the “social” factor is fundamental to lower health costs. The World Bank has recently admitted to have made a mistake by not banking on development. The awarding of the Nobel prize in Economic Sciences to Amartya Sen180 in 1998 is a clear example of this trend, as are daring projects such as that of Mohammed Yunus who, in Bangladesh, one of the poorest countries in the world, has set up a bank which offers tiny loans at low rates and against no guarantee, thus allowing millions of people to free themselves from usury and exploitation. Before being an economic issue this is a world view. Let us revert to our microcosm, therapy. In terms of space and time, it definitely needs to be reassessed. Time becomes the time of the therapist, who shall be more careful to the patient‟s, besides his own. Boscolo and Bertrando181 describe what the worker‟s action should consist in, that is, fitting in among the three time dimensions the self-reflective chain of present, past and future, searching for hypothetical pasts and futures in the present. Hence, the possibility to create “new stories” by renouncing the old ones which forebode suffering. But time is related to space which is no longer the tamed space defined by the safe walls of an office, a medical centre or a hospital, but that – at once physical and mental – of a multiverse with mobile boundaries which often extend beyond the pre-defined one. In other words, it is a real “street” space, that is, permeable to influences and interferences also from other places. Accordingly, mental health workers become more similar to “street workers”, more careful to what happens “out there”, more curious, less frightened to distance themselves from techniques – a safe harbour for methodological purists – and, thus, ready to sail into open sea towards “other” drifts. The community, the parish, the home, and other meeting places acquire “friendly” meanings, as chains of a single story which weld and join with the standard place of care. They are the arms of the same body, even though they are often distant from each other (sometimes more mentally than physically). This example can perhaps provide a representation of the meta-levels that we have always desired, whispered or just sketched, often with a very low awareness, and towards which we always claim we tend. The families

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The awarding of the prize was justified, among others, by the following merits: for making fundamental contributions to welfare economics, for having applied a consistent approach in his studies of social choice, welfare measurement, and poverty and for his extensive studies of the origins of famine. Boscolo, L. and Bertrando, P. (1993). The Times of Time: A New Perspective in Systemic Therapy and Consultation. Trans. S. Thorne. New York: W. W. Norton and Company, p. 70. (Originally published as: (1993) I tempi del tempo. Una nuova prospettiva per la consulenza e la terapia sistemica. Turin: Bollati Boringhieri).

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that we previously might have described as under-organized182 and poor, could thus become meta-organized, that is, able to tell a meta-story going beyond the meanings, beliefs, and family myths that have often hindered their development. Another important contribution on these issues, that we would do well to re-discuss today (and update as necessary, starting from the concept of family itself, whose evolution is a permanent process), is that of Aponte (1979-81)183 who describes the under-organization of lower-class families as “a deficiency in the degree of constancy, differentiation, and flexibility of the structural organization of the family system […] a lack of organizational continuity of the family with the structure of its societal context”. The author reports that we often have to deal with people who have grown up permeated with the “culture of poverty”,184 the generating matrix of all those who live in conditions of “structural poverty” at personal, family and community level. This last border crossing is also a sort of common heritage for the systems-relational therapy thinking which, today more than ever, needs inter-connecting differently with its own roots (that lie in Bateson‟s proposal for building bridges between human and exact sciences). Minuchin‟s and Aponte‟s first works are topical because they “dare” to cross the welldefined boundaries of family therapy and enter the social and cultural fields. An exaggerated technicality has led us to forget that research into the family is a social practice that the worker/researcher carries out also by calling into play his patterns of normality, deviancy and therapeutics, and by analysing the sociocultural context of the family not only as a background, but, especially, as a major element. The new kinds of family groups (mixed couples, family reunions, adoptions, etc.) which are emerging in Italy require that we – as common citizens, rather than psychiatric workers – deal with, for the first time, inter-actions, emotions, behaviours, and prejudices completely unusual to us. The prospect is to create further opportunities to approach these families and “cross the distances” to reach people with problems rather than people‟s problems. Let us reflect and see whether at times, fearing a shifting of contexts, we have renounced poking our nose outside, an outside which, in fact, was not outside at all: it was simply a “widened inside”!

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The terms “underorganized” and “disorganized” have been especially employed in the following essay: Minuchin, S., Montalvo, B., Guerney, B. G., Rosman, B. L., and Schumer, F., Families of the Slums: An Exploration of Their Structure and Treatment (New York: Basic Books, 1967). The authors perform a deep analysis of twelve families which they describe as disorganized or underorganized and belonging to the “culture of poverty”, highlighting the dysfunctional communication patterns which hinder their development. The conclusions they reach especially concern the ways of communication typically used by therapists who, when dealing with these families, should be practical, that is, employ acts rather than words, by showing what is happening (some of the family members were invited to observe through a one-way mirror how the others communicated). The authors‟ goal is building bridges to get into contact with or closer to the family by using all available resources. I remember that, at the beginning of my education path, during a family therapy training course in Rome (I was about to get my psychiatric specialization certificate then), Salvador Minuchin asked me: “Are you a paediatrician? Are you married? Have you got children?” When I answered negatively, he said: “Then, why do you want to deal with family therapy?” 183 See: Aponte, H. S. (1976), Underorganization in the Poor Family (in P. J. Guerin (ed.), Family Therapy: Theory and Practice, New York: Gardner Press, pp. 432-448); Aponte, H. S. and Van Deusen, J. M. (1981), Structural Family Therapy (in Gurman, A. S. and Kniskern, D. P. (eds.), Handbook of Family Therapy, New York: Brunner/Mazel). See also: Ancora, A. (1995), Psychosis and Culture in the Family Process (in Acts of the XV World Congress of Social Psychiatry, Rome, 1-5 September 1995). 184 The concept of the “culture of poverty” is illustrated by O. Lewis in Five Families: Mexican Case Studies in the Culture of Poverty (New York: Basic Books, 1975) and in La Vida: A Puerto Rican Family in the Culture of Poverty - San Juan and New York (London: Secker and Warburg, 1967).

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Now I shall pass on to the description of some of the therapeutic sessions I held with a few non-Italian families who turned to the Roman mental health service (district B) where I work, in the south-eastern suburb of the city (the same as the one which the Italian families whose cases I have previously described applied to).

5.1. MIRCEA AND HIS THREE ROMANIAN BROTHERS The first contact takes place at the hospital. The service where I work is required to intervene because in the area within its territorial competence a Romanian young man has been hospitalized, apparently suffering from auditory processing disorders (voices tell him to break anything within reach). I learn that he illegally migrated to Italy two years ago (later on he will reveal that there are two possible access ways to the country: through Slovenia and then Trieste, and through Germany and Switzerland). His family of origin lives in northern Romania, in a village bordering on Ukraine. He lives in Rome with three brothers who work in a circus. He was happy in Romania, as he has been so far with his life in Rome, where he has also worked as a builder. In relating his story, I shall endeavour to describe the highlights of the part we have lived through together, that is, the most significant sequences of the therapeutic process. Second encounter. At the service. He looks frightened and speaks a poor Italian, as if mumbling. He asks whether we also feel the presence of the devil in the room. Mircea, his brothers and we, the team members (doctor, social worker and nurse), are seated in a circle. We ask him if he has a religious creed. He says they are Evangelists. On Sundays they gather with their community – almost entirely from Romania – in a church-home to practise their cult. He hints at some differences between his religion and Catholicism. We would like to know better their habits and meet the community, maybe on Sunday, towards 11 a.m. (as we are informed later). We talk about Mircea‟s country, his culture and the Carpathians. His eyes seem lighting up. We set a common objective: helping him to feel better so that he can decide whether to go back to his country or not. To do so, however, it is necessary to make a pact against the devil, all of us together. As we declare this alliance, we tightly clasp our hands, as it happens in certain religious practices. Only by moving in this direction together can we become stronger than the evil spirit. The physical and psychic embrace is much welcomed by Mircea and some peace and relax finally appear on his strained and drawn face. For the time being we say goodbye and remind him to follow the pharmaceutical treatment he has been prescribed by the hospital doctors. In reality, the “simple” objective we have sought to achieve in this first phase is to show clearly our desire to welcome not only Mircea‟s problems (the voices, the devil, etc.) but also Mircea himself, his people, and his country, in order to know him, and his world, better. Third encounter. The Carpathians are not so far. He comes with his brother Piero, who is a sort of leader in the group, even though he is not the eldest, as we will come to know at a later stage. Piero has had to leave his job in order to stay with his brother night and day. He says: “I don‟t want him to be hospitalized any more”. Mircea complains that he can‟t stand it any more. He always feels to be “controlled”. He also believes that his brothers keep on him too a tight watch and does not feel to be adequately protected by the Romanian community. “They don‟t know that the devil is around

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and that is why I have to be on my guard all the time. His power is very big.” “Maybe it‟s time you introduced him to us. Can we talk a bit of the devil? What does he look like? Does he look like someone in particular?” “Yes, he does. He looks like a very bad person whose name is Giulio. He did me much harm. I worked for him, but he had „other purposes‟. Would you believe it? I still have 400 euros that he gave me because he owed it to me. Though I need to use it, I don‟t because it brings bad luck.” Actually, by encouraging Mircea to introduce the devil, we want to “materialize” it, so that he can be less frightened and more in control of himself. The objective is passing from the idea of an unspecified “ghost”, who is terrorizing as such, and cannot be fought, to something more concrete, although still frightful, which can be faced up to, especially when alone. This is also a good opportunity to test the strength of our pact. We have an idea: “If one day you take us this money of yours that brings bad luck, we will exchange it, obviously to the same amount, with notes collected among us. We will see if this new money can help us to strengthen our pact which maybe so far has not been strong enough.” The gauntlet has been flung down: on one side, there are the “negative” forces that grip Mircea, who feels confused and distrustful to such an extent that he does not know whom to trust; on the other side, there are us, provided with the “thaumaturgic power”, the clean money, whom he can consider as the good forces with whom to ally himself. This physical “representation” gives us the opportunity to make him feel our nearness, helping him to pass from an uncomfortable position between two opposite forces to one less distressing and better defined. But this transition is not easy to make. At one point, Mircea, frightened, turns his eyes towards his two brothers (once he comes to the session with both of them) with a questioning look. He is anxious to receive a signal from them (as he will report later), believing to have disappointed them. He feels to be the weakest of the family and guilty about making them lose time and money. Following Dunn and Kendrick‟s theories,185 I think about the experiences he didn‟t share with his brothers in his childhood, which haven’t allowed his differentiation. The general impression is one of a homogeneous whole, a single context of religious, cultural, and family experiences, where Mircea‟s brothers play the role of a “press office” and distribute overlapping communiqués, that repeatedly and strongly assert a family unity and an ethnic identity which are inescapable. Moreover, there is an atmosphere of control that Mircea shows to confirm by continuously asking his brothers, through his eyes, to approve his words. Considering the facts so far witnessed, in the following sessions we focused on the reports about the brothers‟ common life in Romania and on the episodes that were more meaningful to them (how they played, who started to work first, who left the country first, their community‟s attitude in relation to their leaving, and so forth). The goal was finding and highlighting the differences, if any, between brothers, as well as their emotional experiences, often unexpressed or stifled, and taken for granted. We sought to make explicit their difficulty to express the features that differentiated them. The chorba soup and the native village. Mircea is accompanied by his eldest brother, who has taken over from the other (who has left on a tour with the circus). He looks blocked and 185

Dunn, J. and Kendrick, C. (1982). Siblings: Love, Envy, and Understanding. Cambridge, MA: Harvard University Press. This work is one of the very few to thoroughly analyze the subsystem of brothers. See also: Kahn, M. D. and Lewis, K. G. (1988). Siblings in Therapy: Life Span and Clinical Issues. New York: W. W. Norton and Company.

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moves stiffly, as if he had been taking too many drugs, which, however, a closer check rules out. His half-closed eyes, his body projected forward, and his trembling upper limbs are an obstacle too high to overcome. Unable to talk to Mircea, his brother prefers talking about him: he has been ill, but they decided against his hospitalization. By taking turns, they have been keeping a close watch on him at all times. In the past two days he has been immobile like this, refusing to eat and muttering something about his country from time to time. The atmosphere is very distressing and we are all embarrassed, striving as we are to fight back the frustration created by such a paralysing context which seems conveying the message “There‟s nothing to be done.” With difficulty Mircea‟s eyes try to open, by making slight movements. I suddenly decide to break the silence by asking: “We are eager to know whether in the village where you come from people eat chorba.” Chorba is a typical Romanian dish, like spaghetti in Italy… Actually, the question is a provocation. Mircea‟s brother answers: “How do you know about it?” “Some friends told me about it after a trip to Romania. They also said that the Romanian cuisine is rooted in that of ancient Rome. We are in Rome. In a certain way this is „home‟.” This similarity is definitely far-fetched and provocative, but the atmosphere of home, whether real or “historically based”, which I attempt to evoke, seems to have an effect. Amid sobs and tears Mircea starts speaking and tells about his home, near the border on Ukraine, about how cold winter is there, about his parents and his other brothers who still live there. “Would you like to go back to Romania?” “How? I have no work and I am ill. What would my mother say?” His brother is listening to the conversation impassively, though he makes some gestures of annoyance. Are we in the right direction? Are we really starting a story together, in the spirit of the “pact” against the devil that we made during our first encounter? It is clear that the creation of a context made of alliances, solidarity, and warmth can finally allow fear to show its true colours: longing for home and loneliness. Does religion help? In our subsequent encounters the horizon became clearer and Mircea‟s story, at first incomprehensible, seemed to take shape, especially as far as the nature of his relations with his brothers was concerned, characterized by strain, competitiveness, and an apparent, feigned solidarity. An important element that kept them united, as happens with many immigrants, was religion. Their religious creed provided them with the opportunity to confirm their sense of belonging to the community, during the Sunday practice. This was an experience that Mircea lived intensely and waited for with much anticipation during the rest of the week. They met in a room in the Prenestino district. These gatherings were the opportunity to meet with other Romanians, sing and spend some time pleasantly together. Sometimes they talked about their own experiences and emotions, but the conditions were not always right for this exchange. That is how these gatherings started being a burden to Mircea, who felt forced to go even when he didn‟t want to. One night, in the grip of anxiety, he even started yelling, so that his brothers carried him out against his will. At a later stage, he commented on the session described above by saying: “That day reminded me of the atmosphere of home.” Another important piece of information was given: Mircea saw his fellow countrymen as a closely-knit whole which couldn‟t be opposed. Discussion with the Micro-Team (Nurse and Social Worker) A colleague of our team asked whether religion could help Mircea or, instead, was covering up his crises. After much work, his brothers had finally been able to tell him in a clear and straightforward manner that they would take him to church only if he really wanted

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to go. This point was important: the religious ceremony was also the occasion for a gettogether with their fellow countrymen and, accordingly, couldn‟t be separated from the rest of the context. These religious ceremonies were to Mircea moments of great strain, rather than occasions for “spiritual recreation”, as they were depicted by his brothers who for a long time hadn‟t understood the reasons for his refusal to participate. Meanwhile, during our encounters, Mircea started to give us details about his religion, the Christian Evangelist, and its spreading in Rome, the centre of Catholicism. By his “philosophizing” he attempted to highlight all existing similarities: “It is very similar to your religion… they are actually the same… but mine is translated into Romanian!” This way of speaking could be considered as a way to build bridges to unite our worlds. Such bridges metaphorically represent the position between two worlds where many immigrants are suspended, a position embodied by religion as well as many other drifts. Their strain and psychic disorders hide, more or less in depth, their continuous efforts to reach the other side, supported by the hope to overcome their atavistic instability and precariousness (which entail serious psychic risks). The objective was, then, to take Mircea, as well as his fears, by the hand. What was actually needed was to help him make his fears more explicit. In particular, this concerned his desire to return home, which hovered about like a ghost and generated ambivalent feelings inside him186. Once this desire would be clearer to him, it was important that he succeeded in communicating it in a straightforward way to his brothers, maybe starting from the one whom he felt closer to, employing possible and not “mad” modes of expression. To achieve this goal, it was necessary to create a relational frame devoid of messages with a double or triple meaning, such as: “We would gladly take you back to Romania, but you are in such a state…”, “If you feel ill in the coach, what will we do?… it‟s a two and half day journey”, “Get well first and then we will see”, “Don‟t you think of Mum, when she sees you like this?” Mircea‟s eldest brother helped us to get out of these paradoxical and menacing traps when, in a session, he announced that in fifteen days he would have to leave for Romania, since it was more than two years that he had been away from his wife and children. By that date he would leave, with or without Mircea. This message was the first to be conveyed, with a certain straightforwardness, in a long while and we sought not to miss the chance it gave us. Together we defined the beginning of a different path of communication among the brothers, rather than a date by which all should have been necessarily ready. This was the only way to allow the manifestation of feelings such as envy, jealousy and competitiveness, which had certainly emerged and yet the brothers lacked the courage to face.187 The following framework was beginning to take shape: someone, among the brothers, longed for home, but couldn‟t say this and “gave” this task to Mircea, who expressed it in an incomprehensible manner. Someone else wanted to see his family (wife and children) but threw the blame on the one who wasn‟t ready for it. Creating a communication context where everyone could express his own desires and pain, instead of repressing or shifting them onto something else, 186

There were times when Mircea said that he was ready to leave for Romania, even by coach (there is an express Rome-Bucharest line and the journey lasts 48 hours). At times, instead, he insisted that the distance was too great for him, the time needed to cover it too long or the weather conditions bad (even in summer). 187 In this session, we found out that, when he was younger, Mircea was considered the most attractive of all brothers. Accordingly, his brothers had always felt as if they had been cast aside, especially by girls who had eyes only for Mircea. They had never talked to him about it for fear of displeasing him. Piero expressed the (stifled) desire to go back home: he admitted before all of us to own a small recorder which he used at night, before falling asleep, to listen to Romanian music.

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could be the occasion for coming closer and establishing a relationship also based on differences. Thanks to this new context we came to know that many years ago “when we lived all together (seven children and the parents) there was not the proper atmosphere to talk about ourselves, to know one another better.” Remembering those times, there could have also been room for yielding to weeping. There wouldn‟t have been any reason to feel shameful: tears wouldn‟t have certainly impaired the pride and the resolution of some to continue working in Italy, and the possibility, for others, to express the desire to go back home, whether definitely or not, without feeling to have failed. These behaviours could give rise to a new sense of “brotherhood”, rather than further conflicts. Mircea had realized that he could start talking freely of his fear about returning home, which, to a certain extent, could indeed prove problematic. He could start from the brother whom he felt more at ease with, thus introducing the first differences into his group, always regarded as a close-knit whole which he was afraid to break. In their turn, the others could start changing their attitude towards him, by considering him as someone they could confide their dreams and fears to. His brother Piero wanted to be close to him, but he didn‟t want to be a guide like a “stick for the blind” (as he himself said during a very dramatic session). Indeed, he finally revealed to Mircea that he also had suffered at the beginning of his stay in Italy, but he couldn‟t confess it to anyone and had wept all alone. Maybe the right time had come to say goodbye, at least for the time being. “If we don‟t see you next time it means that you have left.” We agreed that we would meet any way, regardless of the desire of each to stay, leave or leave again. We had the impression that, in any case, another difficult journey had started.

5.2. SABREL AND THE NOMAD CAMP: (FORMER)188 YUGOSLAVIA AMONG US Sabrel, aged 18, from Split (Croatia), has a persecution raptus after giving birth to her second child. She wriggles, tosses about, and yells in a Roma camp in a remote suburb in Rome. She is hospitalized. After her dismissal she is sent to the service where I work. The newborn, a girl, is taken to an institution, pending the decision of a juvenile court judge on her possible adoption. The elder child is left at the camp with his father and grandmother. The following framework can help understand more accurately the evolution of this story. The micro-team who worked on this case gave a title to each encounter based on the most significant sensations stemming from it. First Session: Olfactory Prejudices, or the Difficulty to Face a Situation for Fear of “Contaminating Oneself” At the beginning, the group (Sabrel, her son, her husband Goran and her mother-in-law) appears tight-lipped and distrustful, both towards the service and its workers. Goran‟s mother is the most authoritative of all. She wants to get back the infant that the court apparently aims to take away from them permanently. The couple seem as if non-existent. The two-year old 188

This clinical case dates back to 2000, when Yugoslavia was still in place.

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boy interacts with his father and his grandmother. We invite Sabrel to take him into her arms, but neither can stand the test for more than a few moments. First consideration: is Sabrel a good mother? Is the court right to take her daughter away from her? During the first session at the service, we note that the small boy moves about in the room constantly putting himself “in danger”: first, he sits precariously in an armchair, risking bumping against the edges of the table, and then he reaches out and touches the sockets. No one cares to stop him. Anxiety and worry seem to concern only us therapists: the family does not appear in the least worried about the child‟s dangerous behaviour. Second consideration: are we, as western, indeed Italian, parents, anxious? Or do we worry about our own children more than parents from other countries? Meanwhile the air in the room becomes unbreathable: one of us leaves the room for a breath of air under the pretext of a telephone call, while another goes out because, as he will admit later, “I simply couldn‟t breathe any more.” At the end, we propose to meet again. The proposal is accepted. Third consideration: are prejudices only olfactory? After such a session, many reflections arise at different levels: from experiencing xenophobic feelings, which one had better make explicit, to finding ways to widen one‟s knowledge on nomads‟ culture, beyond all stereotypes. It is important, in any case, to make room for “that human feeling of relief” that we gave way to at the end of the session and, at first, didn‟t feel brave enough to admit. The impact of the encounter with such a universe proves difficult also physically and immediately leads one to reckon with one‟s own weaknesses, inner constraints, and cultural limits, without traumatic “leaps”. Moreover, one is involved from the viewpoint of one‟s prejudices, fears, and imagery built over time. Sabrel is alone in two ways: the nomad camp where she lives is that of her husband. Her family of origin lives in Turin, in another camp, and the two clans are not apparently on good terms. She feels oppressed by this environment and she is probably not strong enough to say so. She wishes to believe that she can actually trust it, but she feels used and, on the other hand, she doesn‟t feel to be protected by her family of origin whom she can‟t even contact by telephone. We decide to get into contact with this family to know something more about Sabrel and, at the same time, to accept to meet her request. We finally succeed in activating the network: the local authorities, the social worker of the municipality of Turin, the social services for emergency interventions, and Opera Nomadi.189 Second Session: the “Three Treatments” Sabrel seems to feel better. She says that she is “accurately” following the treatment prescribed by the hospital. She reports to have been at the mosque where she asked the imam to bless her medicines, so that she could feel more secure. She has also procured a small holy picture of Father Pio because she has learnt that all over Italy he is considered a good person and has performed miracles. First consideration: the imam could represent her attempt to put back together her story, interrupted by hospitalization, by reconnecting it to her cultural and religious roots, as well as the confirmation of her own existence, her identity – searched for with so many efforts –, and her origins. Father Pio could express the research for an additional help to recover from her

189

An Italian association dealing with nomads.

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illness, as well as her hope to receive a sort of “consolation”, the closeness of the culture of the country where she lives. “Maybe I can trust a country where they believe in such a good man, a so deeply loved saint… The doctors of this country want to know me to help me, to understand my suffering. Will I let them help me?” Since we lack some elements in our journey towards knowledge, after a brief discussion where we ask for “practical information”,190 we propose that the next encounter take place in their camp. Our proposal is accepted. We leave for the nomad camp. It is far, in the suburbs, where the city slowly thins out. Merry children say hello to us as they throw back and forth a bicycle frame with no tires. The first part of the camp seems orderly: caravans and cars are parked in a row, almost perfectly in line. We will learn that the Serbian community has settled here, united and apparently efficient. In the second part there are mostly Croatians and here, too, a certain order is noticeable. But there‟s still no trace of Sabrel. Eventually, we look for her in the last part of the camp, where there are only clapped-out caravans and tin-roofed huts which, arranged most disorderly, give more the impression of a mass of things and persons than a camp. We find out that in this area of the camp there live nomads from Bosnia, Mostar, Sarajevo, and Herzegovina. From the ethnic point of view almost all of former Yugoslavia is represented.191 Someone says to us that things are fine at the camp, whereas others almost silently accuse the Serbs to boss around and say that there are often fights.192 Sabrel and Goran did not expect us at this time. She is holding her child in her arms looking at him tenderly. They show us their wheeled home and a hut where they have their meals, which he proudly tells us to have built himself. Sabrel‟s mother-in-law repeatedly asks us whether we will draw up a positive report about Sabrel, who is well and feels no more persecuted, as she will confirm herself. Her mother-in-law insists: “It‟s high time the baby were taken back home and were not placed in foster care.” In the meantime, we have learnt from the social worker that in the last few days Sabrel travelled around Italy, and every time she was stopped by the police she said she was “wandering” looking for her family. She finally succeeded in getting to Turin, but then she found out that the camp where his parents were had been moved and she had been taken back to Rome. However, Sabrel still feels “endangered”, even though to a lesser extent than before. Looking around, we realize that the place is, indeed, far from reassuring: potholes which have never been filled up have become small ponds, puddles are everywhere, and naked children all around the place add to a picture that is more similar to the television images from the Balkans that we watch daily than to those of a city getting ready for an event such as the Jubilee. Rumours have spread that “the people from the mental centre” are there: many nomads come nearer to ask questions on head and brain ache. We answer as we can and say 190

Working with immigrant families also entails getting answers to non-psychological questions: this is an integral part of the reception phase of the consultation or the therapeutic process. In a family-centred view this would be considered as a “shift of the context”. Yet the possibility to create multiple realities needs, also conceptually, a “decentralized observation”. 191 On this point see: Klain, E. (ed.) (1992). Psychology and Psychiatry of a War. Zagreb: Faculty of Medicine, University of Zagreb. This interesting book describes the psychological damage produced by ethnic conflicts and persecutions of gypsies in former Yugoslavia. After the conflict, allegedly around 40,000 Roma people fled to Italy, adding up to the 70,000 already there. See: Campani, G., Carchedi, F., and Mottura, G. (eds.) (1998). Migranti, rifugiati e nomadi: Europa dell’Est in movimento. Turin: L‟Harmattan Italia. 192 To give an idea of what life is like in a nomad camp, I shall report what I was told by Sofia, a nomad living in the same camp as Sabrel and whom I have met elsewhere, in town, in a non-working context. This account follows that of Sabrel‟s case.

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that we have not gone there to set up an outdoor outpatient clinic. Actually, we realize that the questions they want to ask are different.193 But we certainly have no answer to give! Then Sabrel comes to our rescue and says that next time it will be her to come to our centre and adds that she will accept to have the injection. Maybe she is pregnant, but she is neither worried nor happy. We say goodbye. “Emotional” and “Intellectual” Reflections in the Car Being a nomad, that is, having chosen a certain life style, does not mean being forced to live in inhuman conditions, such as those that we have witnessed. The matter here is not being feel-good or patronizing, but simply keeping one‟s eyes wide open, at least for once. It would be easy to “declare war” on authorities and accuse society (which we also belong to) for allowing the existence of such barbarism. Psychiatric symptomatology is just one of the problems! Basic life conditions are continuously violated and, given the close similarities at the ethnic and national level, it is difficult not to mix up this reality with the one that television broadcasts daily, in these sad times of a fratricidal conflict going on between a part of Europe that has declared war to another and this one to yet another one (it is May/June 1999). We think of all the efforts that Opera Nomadi still has to make to make the Roma culture known, an ancient culture deeply rooted in Italy (at least since the XV century according to Masserini, 1990). Notwithstanding its Indian (Aryan) origins, the Roma people have always been persecuted, also during Nazism. Sadly, whenever they are mentioned, it is always in connection with crime or public order problems and never their culture. Dealing with Sabrel has represented for me the opportunity/necessity to plunge my feet into water that is so deep, cold, and muddy that it only makes one wish to get them out immediately.194 This people cannot be considered just as “stealing gypsies”. They are to be regarded as victims of continuous persecutions (the situation in Kosovo is typical: they have been “chased out” by the Serbs first and the Albanians afterwards) and as a people who, as any other people, include honest as well as dishonest individuals. Chatwin195 advocates that nomads should be observed just as they observe us, by looking at civilization with envy or distrust. “By civilisation I mean „life in cities‟, and by civilised those who live in the ambit of literate urban civilisation. All civilisations are based on regimentation and rational behaviour.” He adds that nomads are uncivilised and all the words traditionally used in connection with them are heavy with civilised prejudices (wanderer, vagabond, savage, etc). According to him nomads necessarily exert a disaggregating influence, but the blame that is put on them is disproportionate to the damage they cause. He also stresses that roaming is a human characteristic generally inherited from vegetative primates and that emotionally, if not biologically, all human beings need a base, a cave, a den, a tribal territory, possessions or a port, which is something that they have in common with carnivores.

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The nomads‟ “hunger” for institutions and authoritative representatives (or, more simply, someone willing to deal with their most elementary needs, such as water, toilets, and sand to fill up potholes) is such that anyone who happens to be in a nomad camp, regardless of the reason for his visit, becomes a potential messenger and upholder of their needs. 194 On this point see: Fonseca, I. (1996). Bury Me Standing: The Gypsies and Their Journey. New York: Vintage. The title comes from the Gypsy saying “Bury me standing, I've been on my knees all my life”, a request, or rather a plea, made by people who were forced to stay on their knees for their whole life and who, at least when dead, wish to resume their standing position. 195 Chatwin, B. (1989). What Am I Doing Here? London: Jonathan Cape.

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By way of conclusion, to highlight the complexity of a world which attracts and rejects us at the same time (one need only think of how we react whenever a gypsy woman stops us in the street to read our hand), I shall remind what historian Geremek196 writes about gypsies. To him the gypsy embodies the typical wanderer, who is a fraud and a charlatan, and, on occasion, a thief. He brags about his supposed occult power, through which he claims to be able to foresee the future and find out the truth. The attitude towards this traditional activity of gypsies, especially women, appear ambiguous: if on the one hand it can be considered as the typical example of the art of fraud, on the other, in the medieval and modern collective imagery, it evokes, in particular, the world of magic. Apart from these thoughts, it's Sabrel who occupies our minds. Before we left the camp she “concretely” asked: “When I recover from this disease, can I have my children back?” Last reflection: what if it were reality to make her ill? A Few Additional Remarks The encounters at the mental health service and at the nomad camp reveal that the conflicts that grip Sabrel are many and at different levels: 1) the relationship with her children, whom she is very attached to, even though her approach is culturally different from ours. In this regard, her behaviour, in relation to her son, at the centre and at the camp was revealing; 2) the conflict with her new family whom she can‟t overcome, even though she really wishes to; 3) the camp which, though being more similar to a non-place, to her is a place, indeed the place, both emotionally and culturally197 (in her fragmented story it may represent a linking thread). The visit to her community clearly showed that the strain between the different components made extremely difficult for her to “belong to something or be someone”. This context analysis allowed us to help Sabrel who saw hostility and threats everywhere (to the point of having to be hospitalized, as we have seen at the beginning, for an alleged syndrome of persecution). Consequently, she might slowly start to “rely on others” and “be trustful”, starting, for example, from her husband, whom she loved a lot, and his family, whom she loved less but who, nonetheless, had been close to her all through her suffering. Generally, I am aware that whatever the intervention decided upon, it affects only a portion of the problem, even though this portion is interconnected with the rest. This was the first time I realized how fragile, precarious and inadequate an intervention could be. Pegging out an area in a nomad camp or setting “limits” to someone who “has chosen” to live permanently on the threshold is not easy. The problem was, rather, to provide a less conflicting perspective of the context and relations with others to someone who felt to be trapped, persecuted and constrained in a lonesome and painful view of reality. 196 197

Geremek, B. (1991). Les Fils de Caïn. L'image des pauvres et des vagabonds dans la littérature européenne. Paris: Flammarion. In Feeling and Form (New York: Macmillan Publishing Co., 1953) S. K. Langer argues that “literally, we say the camp is in a place, culturally, it is a place”.

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To provide some more information on such a varied world as the nomads', 198 I shall include the account below, evidence of what may happen when I am confronted with ordinary, non-psychic problems, while I walk in the streets… Sofia: The Life of an Ordinary Nomad Woman Sofia is there every morning, save in winter, when it is cold and rainy: her “usual place” is a small square in a residential district of Rome, surrounded by smart buildings. She is proud of this “spot” which she has been occupying for years. Every morning her husband takes her there in his old Ford and, after dropping her, he goes to work, that is, “looking for cardboard boxes” (he cannot find copper any more). She is calm, tidy-looking, discrete, silent and looks still young. She does not disturb local residents. Shopkeepers know her… there is an exchange of greetings, someone gives her some coins and walks on. Sometimes she lets herself go and talks about herself. All her children go to school. The school bus stops at the camp: she does not want to leave them on their own there. She does not like the camp assigned to her family (the same as the one where Sabrel lives) because living with other ethnic groups is not easy. She is proud to say that, as a tradition, her family has always lived on “offers”, unlike other nomads who make a living in other ways. She is Croatian and has been living in Italy for over 20 years. Her father lives in another camp outside Rome, which she describes as a “paradise”, unlike hers where, after the last days of heavy rain, the gravel laid by the relevant municipal service has been washed away and large potholes full of water have reappeared. Living in this way is hard, especially because she has to raise small children (who, however, are all fine, in good health). She loves her children and cares very much for their food, which she provides for thanks to the alms she gets every day (just a little money). She is proud to work, that is, gather the money that people give her, within this strange relationship that she has established with them over time. Her sister-in-law does not work. She stays at the camp all day long and, at night, when it‟s time for shopping, they go together to collect “leftovers” in the rubbish container of the supermarket nearby (often food whose “Best before” date has expired). She is also proud to help her mother-in-law (whom she regards as an old woman, even though she is just over fifty) who lives with them. She is aching all over because of arthrosis and cannot look after herself. Sofia‟s brother-in-law couldn‟t care less and, indeed, doesn‟t even care to bring her some wood for the fire. At the end of the morning, Sofia goes back home with her husband. She has to tidy up the hut (they are in seven), do the washing… the bathtub has a hole in it, it needs to be repaired… She would like new window curtains, to enjoy some privacy, even though life is always lived in the open at the camp. Maybe some of her friends, from the square, can get some curtains for her. She also needs a new pot, a larger one, where a “whole hen” can be cooked, the dinner for her large family. Maybe she can get also the pot from someone from the square. At the end of the day, Sofia‟s face looks tired. But she still has to bathe her smallest children, even though the tub has a hole in it. She has to fetch water at the fountain. In the camp there are no showers. There are only toilets, locked and in a poor state… “But I can‟t complain. There's always someone who gives me a hand…” 198

On the Roma people Revelli wrote Cronaca di un campo Rom (Turin: Bollati Bolinghieri, 1999), where he reports his daily life with a group of nomads, coming from Romania, who have settled down near Turin. After highlighting all new and old prejudices (on both sides of the political spectrum), the account ends with the issue of an expulsion order addressed to them and the dismantling of the camp. The wave of intolerance which has recently risen in Italy, that defines itself as a non racist country, is turning into violence, as showed by the recent fire which destroyed a whole nomad camp in Naples.

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5.3. THE TIGRINYA199 FAMILY200 They apply to the centre to ask help for Isaac, aged 21, who has been manifesting aggressive episodes since his childhood. During his adolescence he went to one halfway house or rehabilitation centre after another, for drug pushing and, maybe, prostitution, as well as many other petty offences for which he has been sentenced to a term in the Casal del Marmo juvenile prison, in Rome. Ettore, his father, broken-hearted and depressed, is the one who reports the facts. The other members of the family are Beraki, his wife, always in her nezela, a white light length of cloth that Eritrean women have been weaving and wrapping themselves in out of decency for centuries (thanks to which they could feel safe during the bloody events that have recurrently marked their country‟s history),201 and Sara, his daughter, who seems suffering from a “collateral disorder” related to the situation. If I were to describe the family group by means of keywords, the following description would result: Ettore, the father: emptiness and helplessness; Beraki, the mother: immobility and power; Sara, the daughter: successful, who sacrifices herself; Isaac, the problem “child” (this is what they call him) who “is looking for home” Finally, the setting is to be taken into account: it is that of the mental health service where I work, a public service, with many people going back and forth, a veritable multicultural place. Actually, workers have different cultural and educational backgrounds, and reference frames are often unsuitable to “clean” therapeutic settings. Considering that the greater the difficulty, the wider the scope of the strategy necessary to find solutions, at the service we have always employed diversity as a resource, attempting to build therapeutic realities particularly rich in cultural and environmental “contaminations”. Every story can indeed provide a further opportunity to know not only the country which it comes from, but also, as in this case, our own habits of mind, which have inherited “Italian-style” colonialism and racism, causes of long-lasting wounds. As de Martino wrote in his introduction to Muntu. La civiltà africana moderna (1961): “Neo-African civilization does not mean fight against western reason, but against its limits, against its not being enough reason, against its own contradictions” (p. XIII). It took us four years to see the family (the parents and their two children) gathered together. Though it is true that the family group wasn‟t large, still it was to be considered “extended” and complex from the point of view of its historical-relational pattern, to such an extent that the presence of all members, as a family group, at the same session (that is, in a shared temporal and spatial dimension), seemed an almost impossible target. The first one to come to the service was, as noted earlier, Ettore, the father, depressed and confused, who told us his story (December 1994).

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Doctor Laura Giustolisi greatly helped in this case and in drawing up the report herein included. The term “Tigrinya” refers to the most widely spoken language in Eritrea. 201 See: Dazzi, M. (1998). Nezelà. Piacenza: Editrice Berti. Eritrea was given this name after the Red Sea (eritros = red), rich in algae and small pearls. 200

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Ettore‟s mother is from Eritrea, whereas his father was an Italian who went to Eritrea during the Fascist regime and set up his second family (he already had a wife and children in Italy). Ettore has many Italo-Eritrean brothers and sisters and lived in Eritrea until he was 17, when he decided to leave for Italy to complete his education and find a job. Later, also his mother moved to Italy, together with the other children. Now they all live in Rome. In Rome Ettore met Beraki, a young Eritrean whom he married when she became pregnant. This detail, that is, being “forced” to get married and, thus, dramatically change the course of his life, is still related by Ettore as a major event, or rather, the unfortunate and irrecoverable event which a long sequence of failures stemmed from, both at personal and emotional-relational level. During our encounters Ettore never abandons such a negative view. The child who was born under this “lucky star” is Isaac. At the time of our first encounter with the family Isaac is 17 and is detained in the Casal del Marmo juvenile prison. His father describes him as a difficult child, who has always had problems in socializing and at school. Interestingly both parents always say “bambini” (small children) when they talk about their children, in spite of their age. Ettore reveals that for the last few months his wife and he have been living apart, even though still in the same house because he has nowhere else to go. Apparently this decision has been taken by her. By way of explanation he talks about conflicts which arose soon after they got married and were related to the upbringing of their children: actually, they have never agreed on anything. He says he is impotent, but it is unclear as to what he means: “Maybe I hadn‟t yet realized my impotence. Maybe I couldn‟t satisfy my wife.” His existential emptiness emerges, as does his fear to lose everything, to be worth nothing, to suffer from a kind of impotence which may be much deeper and more serious than the sexual. As far as his work is concerned, despite he got a secondary school certificate, he has always done menial jobs. He is depressed, confused and expects moral support and a dialogue from us. As to Sara, their second child, 15, he only says: “She is fine. She is good at school.” After a few encounters with the social worker, Ettore is not to be seen for over six months. When he finally shows up, in May 1995, he is with his son. Isaac has just finished his term in prison and wishes that we found him a job. He feels attacked by his mother who calls him a thief and a criminal. He talks a lot about her. His father, instead, wishes that he first got his compulsory education certificate. We propose to Isaac to hold sessions with us in order for us to better understand his family situation. After a few months Isaac goes back to prison, this time to Rebibbia, an adult prison in Rome. It is October 1995. For one and half years Ettore is not to be seen again, whereas Beraki comes to see us, worried about what will happen when her son comes back home (October ‟95 - July „96). In January 1997 Ettore comes back to the centre, on his own. He says that the atmosphere at home is strained and that he feels powerless, unable to face this situation, as well as that of his son who is still in prison. He says that he has come here under his wife‟s suggestion, with the aim to find help for Isaac who will be free again soon. After a few encounters the need to work on the couple “to help Isaac” is clearly established. They admit that they didn‟t really want each other, they did not choose each other, they were forced to get married. They started arguing in the first years they were together, even before getting married. Then she got pregnant. They relate past events as if they had occurred recently (“apparently” she does not

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understand Italian perfectly and talks to her husband only in Tigrinya; observations on the use of language shall follow) by using the present perfect tense (“you have told me…”, “you have looked at me in this way…”). The emotional nearness of the past is very evident. They are both vindictive and completely disillusioned at the same time. When Isaac was born, they both worked, he as a workman, she as a help in a household. Ettore repeatedly blames Beraki for keeping working also after their children were born, for caring only about work (the only issue on which they agree is the need for preparing the family to welcome Isaac when he gets out of prison). When the second child was born, Isaac was sent to a boarding school, where he remained for the whole compulsory school cycle and where his first adaptation problems emerged. “He always asked for his mother.” They also stress that he has always been restless and aggressive. According to Ettore, all problems are caused by the fact that Isaac was “abandoned” by his mother who, thus, could go on working, disregarding her culture of origin (also in this case, refer to the final observations). Beraki objects to this and claims that the reason does not lie in the boarding school: the proof is that Sara, who got into a boarding school some years after, has never had any problems and has always been proficient at school. In Beraki‟s opinion the real cause is the conflict between them, the fact that Ettore yells at all times, is always angry with everybody, and sometimes beats her. For many years Ettore has been unemployed, whereas Beraki has always worked in a household. He blames her for not staying at home and looking after their children, for having betrayed her role as an Eritrean mother. In her turn, she blames him for not looking for a job. “Someone must stay with the bambini” he retorts. As far as the household financial management is concerned, things are not clear. Beraki gets a pay, but this is not recognized in the least by Ettore who accuses her: “You waste all the money to get the children whatever they want.” To him it‟s her who has “spoilt” them, especially Isaac who totally depends on her and, therefore, has always gone wrong. When Isaac was 13, his father decided to take him to Eritrea to “keep him far from bad company”. Ettore‟s plan was to find a job for himself and his son in Asmara, with the help of some relatives of theirs, and ask his wife and daughter to reach them at a later stage. They lived in Asmara for one year. Then the plan failed “because of the mother” who refused to reach them and Isaac missed her too much. This attempt, which evidently cost a lot to Ettore, was completely belittled by Beraki. They acknowledge no parental capacity to each other. After a few encounters with the couple, we propose to meet with them and their daughter. They are sceptical: “She doesn‟t want any more problems. She does not want to think about her brother”. Yet, at the following encounter they are three. Sara has come to talk about Isaac. She is in awe. She is seated between her parents and initially she refuses to speak. Slowly she makes clear what she really thinks of her brother and eventually adds that she will leave home as soon as Isaac comes back “so that Mum and Dad can look only after him”. Sara is not 18 yet (her birthday is in two and half months) but she claims: “I don‟t need them. I can take care of myself.” Her father seems supporting her plan, even though he is doubtful because of practical problems, such as finding an accommodation for her and helping her financially. Sara insists: “If I can‟t find a flat, I will go to a girls‟ boarding school. In any case, I am used to it.” Beraki does not make any remark. The impression is that there isn't any room for a family in their house.

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During the following session Sara describes what to her an ideal family is. Rather than an ideal family it is quite an ordinary one: the father works and the mother stays at home with the children, nay, with Isaac. Sara is seated between her parents, she is calm and confident of what she is saying: “The mother must stay at home and look after the children. I have always suffered because my mother didn‟t kiss me, unlike the other mothers.” Her father comes to her help by saying: “I also suffered for the same reason. Eritrean mothers are like that.” All four of them. Isaac has left the prison and all four participate in the session. They are happy and yet worried. They have decided that they will all remain at home and Sara will help Isaac to reintegrate himself into the neighbourhood and make new friends. For all of them what counts most is that Isaac finds a job. However, after some time, problems re-emerge and Sara and Isaac start arguing again because he is jealous of her and her life. We describe these quarrels as physiological in a readjustment phase, the key word of which is: you are no more used to be together. Isaac cannot bear this situation. He argues with his father and attacks his mother. Within the couple conflicts are as few as ever. Isaac goes through crises of explosive rage. He is hospitalized. Sara decides to move and live with a friend of hers. Ettore helps her financially. At this point, the whole therapeutic framework is changed. 1) After his dismissal from the clinic where he was hospitalized, Isaac has to follow a pharmacological therapy. To this effect he will be individually treated by a psychiatrist of our service. 2) Ettore and Beraki ask for help to reunite their family. They will follow a treatment as a couple. 3) Sara needs to be left out of all treatment. There shall be a psychiatrist for Isaac, a therapist for the parents, a social worker to start a rehabilitation process, and an overseer to co-ordinate the work. The family‟s and our confusion are made explicit; the new arrangement is fully explained, the key word of which is: everyone has to accomplish his own task. The general criterion is that everyone has to follow his route and think more of himself, all the while taking the others into account and collaborating. Sara decides that during the summer she will go to London to work. Her choice is supported by all. The impression is that a new kind of “order” is being defined. Ettore and Beraki regularly come to the therapeutic sessions. Isaac takes the medicines prescribed by his psychiatrist. Sara comes back to Rome and decides to resume school and live with her family again. For the first time in years Ettore finds a job. At home quarrels are fewer. Isaac suffers a lot for not having a “place”. He is proposed to attend a daily rehabilitation centre. The key word of this period is: you are making many efforts and something is happening. Unfortunately, Isaac is arrested again because he has to finish serving an old two-month sentence. All take this piece of news very badly, as if it proved their failure and ineptitude. During sessions, the two parents express their desire to trust Isaac to “third parties because we failed”. On this point they say they agree, even though admitting to agree on something is extremely difficult for both of them.

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Beraki visits her son in prison, unlike Ettore who says that “he refuses me”. “What does Isaac expect from us? What does he look for in a father and in a mother?” From his mother he expects material care, whereas, as far as his father is concerned, “he wishes that I set him free, but I can‟t”. At this point we make the following observation: “You have always lived united by the problem represented by Isaac, when he was very small, when he was at the boarding school, when he caused the first problems, when he went to Eritrea, when he was in prison, and this year, when you all have remained home, together, for him, to help him. In short, whether at home or not, Isaac has always been your linking chain. When this ghost is no longer among you, will you be able to start to look at each other again?” During these years the great difficulty of this couple to separate has clearly emerged. Actually, their separation has already occurred, on many levels. What needs to be defined are the terms of it. Beraki has been playing the role of someone who has taken this decision long since, perhaps since the very beginning: “It‟s him who doesn‟t want to accept it.” She is as hard as rock. Ettore, instead, manifests the existential emptiness of his family as well as his personal feeling of abandonment and loneliness: “It‟s them who hold the power.” But he also expresses his strong determination not to abandon the field, unable to give up the little he has, such as the house, and leave it to his wife and children. In a certain way, now separation seems more possible: their being united as a halfway real family for more than a year and their achieving results, after much effort, all together, for everyone‟s sake, sort of allow Ettore and Beraki to take a decision and get separated for real – considering that so far they have been dealing with this issue from an idealized point of view. Now what sort of help do you want as a couple? Help to get separated or help to learn to look at each other again? Getting ready for Isaac‟s umpteenth release from prison is an experience they have already gone through and not so badly. Now it is important to make clear that Isaac will find slightly different persons, who are more distinct from one another, and who are learning to express their own opinions straightforwardly, to engage in a long and difficult process to identify themselves as parents in a new culture. There is more order and there is also a quest, finally made explicit, for autonomy, for a non-dependent relationship between them. So far I have dealt with the account of this case as if I had filmed facts, that is, the work of my team with this family, by limiting remarks as much as possible, with the aim of adding observations and considerations into a cultural and therapeutic framework. 1) Typically, in Eritrean families the mother is hyper-protective and keeps her children with herself all the time. 2) Language as a system of power: apparently Beraki, the mother, cannot speak but Tigrinya. During the sessions she is often silent, does not understand or does not “want to” understand. Within the process of identification in a new culture, language can make people closer or take them apart, play a role of belonging or exclusion. The mother is the one who has clearly showed her attachment to her origins as well as her difficulty of adaptation, whose burden she, as an immigrant woman, has “felt” more heavily than her husband. At the same time she uses language in her relationship with her husband to sort of remind him of the place where he comes from and that, according to her, he wants to forget to “Italianize” even more. 3) The longing for Africa has never been explicitly lived through as an opportunity to express pain, difficulty, and melancholy: it has always been on the background,

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4)

5)

6)

7)

8)

202 203

almost removed, only to re-emerge as returns/escapes. I couldn‟t fully understand what kind of relational pattern this couple had developed in relation to their culture of origin, apart from a general one of love/hate. Within the couple this could have been a common matrix of present and past experiences to use as a starting point for building their identity (ethnic, as a couple, etc.). It is indeed true that, culturally speaking, the father has a more “peripheral” role, but, apart from this fact, that is typical of our culture, in Africa the mother is the central figure. In almost all cultural and social contexts of the African continent, nothing can be conveyed without the mother (as traditional healers202 teach, when, for example, they ask the mother whether she agrees that the whole family group be taken to the village “clinic”, if the disease being identified does not simply affect an individual but involves the whole group, as previously described). At the sessions, we often made them “see things”, by rendering things physical instead of explaining them by means of abstract concepts. Making events – and, in this case, also aspects of their confusion and disorder – concrete was an attempt to approach their culture, the one in which they grew up, which makes visible and touchable all events. In their relationship, made of denials rather than affirmations, cultural identity is not taken into account in the least. Actually, it is sometimes forgotten and any effort made to assert it is opposed. Sometimes the impression is that of a couple without a country.203 The father‟s cultural ambivalence (he is Eritrean/European): in a way, to him it is convenient to go by his culture of origin (which, in other ways, he seems to have forgotten) according to which the mother, the main figure of the family group, is responsible for all. And yet he also finds it convenient to think “European”, especially in his relationship with his son, which he plays down all the time, as if theirs were a relationship between “equals”, grown-up men (however, this attitude might also be a way to get closer to the new culture, with which, in a way, he still attempts to identify himself, even though his migration to Italy dates back to a long time ago). The family‟s instability – not only financial but also emotional (in the sense that it is not easy, in such a situation, to convey emotions) – makes the search for identity more difficult than it normally would be for an immigrant. In this light, a behaviour of the “here/there” kind is understandable, a behaviour which brings to failure both the attempts to go back to Asmara and the decision to settle once for all in Italy (especially with regard to the father-son dyad). Considering the story built together with them, the goal was set to help them to go on along the path towards cultural/social identification, on the one hand, and personal differentiation within the family system, on the other. In any case, they could be accompanied only during a part of their journey. Then, they would have to go on on

Cf: Ancora, A. (2006). I costruttori di trappole del vento. Formazione, pensiero e cura in psichiatria transculturale. Milan: Franco Angeli. Jacques, A. (1986). The Stranger within Your Gates: Uprooted People in the World Today. Geneva: World Council of Churches. The author, in charge of migration at the World Council of Churches, offers an insightful psycho-social analysis of those immigrants who fail to create their own time, spatial, and cultural dimension, even after a long time since their migration. Their ever-present feeling of “suspension” makes them lose their original sense of belonging.

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their own. Accordingly, the care system could become, with them, the narrator of a micro-story to be built together, but not starting from scratch, as they “believed”. Indeed, to write a new piece, actors were needed (and not walk-ons, as they proposed): rather than being the outcome of dysfunctionalities within the family system or any of its subsystems (the couple, the children), the crisis stemmed from an unacknowledged cultural clash, even though the scarce availability of identifying elements seemingly showed their unwillingness to find a clear-cut identity, based on the decision to belong to a given culture. And yet, the “tortuous” references to origins, the idea one had of the other‟s role, the flights, and the interactions only aimed to repression witnessed that someone couldn‟t give up his origins, but couldn‟t say it. The setting could provide a good starting point to set in motion the difficult identity processes, get out of ambiguity and walk across the ford, reach the other bank, to finally indulge in memories, at least, of one‟s country of origin and give way to one‟s longing for home, letting oneself go, even if only for an instant. Continuing with encounters together, within a service providing a help-treatment thus defined, with these objectives, also required that everyone define himself, thus beginning to belong to something. In other words, by generating new patterns of communication, the system of treatment also aimed to highlight the existing cultural clash (besides the one within the couple), between the one who felt to have acculturated and the one who didn‟t, and the one who straddled, with ambivalence, two banks and the one who didn‟t. Embracing a new culture necessarily entails a concrete and explicit risk which lies in the new burdens and responsibilities that one has to take on while attempting to leave behind the “ghost of the old culture”, and emotionally giving way to the desire to go back which one couldn‟t/didn‟t want to indulge oneself in ever before. “Can we keep to our own values without feeling threatened by those of the others?” In such a system, does the assertion of oneself (husband, wife) have always to be offset by the negation of the other (parent, child)? The differences between two generations often reveal themselves through cultural clashes/encounters: the needs and desires of the fathers‟ generation are so remote from those of the children! The old fatherland is often a legacy of the parents. The new generations tend to identify themselves with the culture of the new homeland, which they often perceive as the only one. Posing the problem, on the part of parents (at least some of them), in terms of the old as against the new is misleading because it would amount to arguing that the horizon only consists in how to belong to a culture that we consider as the only one to reckon with and in the shortest time possible. Indeed, the temporal dimension is another “objective” category that separates the subsystems of such a patterned family system, where apparently there isn‟t room for differentiation, not only individually, but also spatially and culturally.

5.4. KANU AND THE CONGOLESE SPIRITS204 Kanu arrived in Italy from Congo (former Zaire) 13 years ago, representing his country in boxing competitions. At the age of 35, when he was forced to stop his sports activity, he found out that his managers had never paid his retirement contributions. Finding himself 204

I thank social worker Anna Iovacchini for her help in drawing up this report and developing the therapeutic project.

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unemployed and with no pension, he worked on-and-off doing the most varied jobs and he was, among others, a builder, a shop assistant and a cinema extra. He has been drinking alcohol since his arrival in Italy, which has caused him real intoxications following which he has been hospitalized several times. He is married to Nemba, a woman from his country but from a different tribe. A few years ago he attempted suicide by throwing himself out of a first-floor window, as a result of which he broke his ankles. As he reported later, his real intention was not to die, but to prevent his wife from leaving him. Indeed, Nemba and he don‟t go along well, even though Kanu has almost invariably denied this. They have two children, who were both born in Italy: Mauro and Alessio, aged 10 and 12, respectively. Mauro attends the last year of the elementary school [NT: first cycle of compulsory education], whereas Alessio is repeating the first year of the middle school for the second time [NT: second and last cycle of compulsory education]. Last summer, while working as an extra on a cinema set (at the studios of Cinecittà, in Rome), Kanu started hearing voices which spoke ill of him. They prevented him from sleeping, he couldn‟t eat or drink any more and he couldn‟t have intercourse with his wife. He was hospitalized in the nearest hospital. This time she was much more frightened than the times he got drunk. At the hospital Kanu and Memba were told about the service where I work and she contacted us. During our first encounter Kanu talks about the episode which brought about his hospitalization. He is utterly convinced that what he went through was real: “I can‟t always explain what happens to me because the evil spirits flee. I can‟t see them all the times, but I can hear their voices. Since I started taking the drops I was given at the hospital I have been feeling better. But I have lost my strength (if it is a boxeur who says this, it is quite meaningful). I can‟t do anything, not even for my family.” The impression is that of a man completely unable to face negative forces stronger than he is. “What language do these spirits speak? Is it Italian or French?” “They speak Lingali, the language spoken in my village.” “Try and repeat what they say. Indeed, translate it (I am aware of the ambivalence of this term) to me so that I can see if I can help you. Since the spirits always flee, if you can, try and write the words on a piece of paper before they „fly away‟.” “I wish to know your family, about whom you are so worried. Will you let me know them?”

Father and sons. Kanu comes with his two sons. Mauro, the younger, laughs to overcome his uneasiness, whereas Alessio interacts more. We talk about the way they consider their father‟s disorder: “He is a bit sad. He was happier before. Maybe he isn‟t all right because he has no job.” “Do you like having a dad who was a boxing champion?” “Yes, he was once!” We break the ice by talking also about other sports. “Do you like soccer? If there were a match between Italy and Congo, which team would you support?” “We would support Italy. We are Italian!”

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The attempt to talk freely of identity and the sense of belonging is aimed to alleviate the distress possibly deriving from the uprooting and fragmentation hovering about and in Kanu‟s previous conversations. We talk about other topics, such as Africa, where the children have never been and would like to go with their parents, “one day, maybe…” (words their father lets slip in one session). At a certain point, the conversation focuses on religion. We venture to talk about this issue with the children, even though it is difficult. The goal is, evidently, to get to their father and know his view on the matter. “What is religion, according to you?” “It‟s a spirit.” Mauro says: “Or rather, it is a good spirit. A spirit in heaven. But Dad says that there are also evil spirits. He believes that only those ones exist!” “We have to help your father, each in his own little way. In his life he fought many boxing bouts but now he has to face a big „match‟, one of his most difficult ones because it is invisible. It cannot be seen because it is fought inside him, between the good and the evil forces. It‟s a tough competition because also the opponent cannot be seen. But we can feel his presence, the pain that he gives, by looking at your dad‟s condition.”

Remarks. The spirits were among us, we could talk about them and make distinctions, they were not only of one kind. The attempt was creating the conditions for acknowledging things that so far had been kept secret, either out of fear or because of certain family rules, and that, however, the family interacted with all the time, feeling their presence, or rather their “invisible essence”. Moreover, since now this matter could be freely spoken about, a climate of confidence had arisen: I could trust both Mauro and Alessio who, although breathing in that atmosphere, didn‟t look frightened. As a matter of fact, they saw their dad as a “fighting” father, though not always winning, and were regretful that the evil spirits had “knocked him down”. Suddenly Mauro said: “I would really like to see this match.” Nemba was the only one absent from this family framework. According to the children‟s accounts, she was a very important figure, but she hadn‟t been able to participate in our session because of work… They are all there. The children laugh and now we know why. Kanu is seated as if he were keeping apart. Nemba stands out in her full “splendour”: she has an imposing presence, even physically. The climate is very grave. Nemba is worried about the spirits that paralyse her husband and she holds the establishment of Italian boxing responsible for his disorders (“It turned the champion I married into a wreck”). She is the one who provides for the family, but her pay is barely sufficient to pay the rent. They are black and “obviously” they have to pay a rent which is disproportionately high, considering their flat is very small and in the suburbs. “My husband does not feel all right because he is unemployed.” The interaction within the couple shows various problems, the most serious of which is that each one feels constrained by his respective mythologies and mutual expectations. The children apparently “look” at things from a distance, as if to protect themselves. Remarks. Kanu‟s role in the family was undoubtedly very modest. The problem was to help him not only by means of an economic benefit, but also by “making him live in his family system in a different way”. The “voices” he heard represented his inability to accomplish this.

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The financial resources of my service and his family are close to nothing. So far, there has emerged much confusion in many areas: religion, roles, family realities, spirits. To “make order”, the following action plan (not only of a clinical nature) is developed: 1) Give a role to everyone (especially to the one who has lost it); 2) Restore a healthy man-mind relationship, recovering harmony and not only conflict, in a relational frame encompassing many voices and presences (thus, considering spirits as an interactive reality); 3) Activate the social network, by using the available resources, to find a job (a difficult task for an immigrant who “does not peddle lighters”205 and is dark-skinned). This means enquiring at sports centres and fitness clubs both in their district and elsewhere (the attempt is to find a job related to his past activity); 4) At a later stage investigate more deeply the relationship between the husband and the wife. Actually, it immediately reveals itself as a very complicated and turbulent relationship which absorbs the little energy they still have. Moreover, conflicts are such that there is no room for creativity and planning, necessary to find the way to venture in still unexplored territories. The first step is to find a job for Kanu. The social worker, one of the members of my team, has an interesting idea (after the failure of our enquiries in the sports field): turning the economic benefit into a salaried job. The idea, then put into practice, consists in integrating Kanu as a collaborator into a cooperative, made up of francophone Africans, which runs a nursery school for African children (a dozen in total). The cooperative benefits from local grants to meet the needs of migrant African families with children who have to be looked after during working hours. The cooperative needs staff and our service has the goal to give a benefit connected to the project aimed to return Kanu his family role, allow him to keep himself busy during the day and protect him by means of a network of fellow countrymen. The contract is signed in a very short time: Kanu shall work for the cooperative (3 days a week) to which the service shall pay a monthly benefit that, in turn, shall be given to Kanu as his regular pay. Psychiatric prejudices have no colour. The cooperative leader, also black, is puzzled when we illustrate the project to him, and asks: “Is Kanu dangerous? You know, there are children here!” This remark takes us by surprise because we didn‟t expect such fears on his part. We believed in the old cliché that “all blacks are brothers” and were confident that a fellow countryman, albeit diseased, would be accepted more easily. Actually, the skin colour is not sufficient to overcome the defensive and protecting barriers that apparently are erected everywhere when the matter is a psychic disorder. However, they are willing to accept him. Finally, a “curious” detail is to be noted: Kanu is starting a peculiar path, considering that in his life he has had many different jobs, but none of that kind. This engagement is something new for everyone. The framework that is about to take shape is as follows: work is the attempt to “normalize” irregular events; the interaction between fellow countrymen is a learning 205

It‟s a manner of speaking for referring to immigrants (who, unable to find a regular job, illegally peddle lighters and other merchandise).

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opportunity for the whole team (proving the difficulty implied by crossing not only “other” cultures, but also one‟s beliefs); now in a less “conflicting condition”, Kanu can finally consider spirits as allied and protecting entities who, thus, can exist even in a country different from his. What about the spirits? We encounter the four of them one month after Kanu started working. Kanu and Nemba seem closer. The children don‟t laugh, but smile, because now they are more relaxed. They quietly ask their father whether they can visit his working place, where there are other children. He answers: “OK. One day I will take you with me!” Remarks: From Decontextualization to an Extended Context The most significant sequences reported allow drawing the following additional considerations. The therapeutic project needs to be extended and later narrowed down. All intervention has to be closely connected to the patient‟s story, the analysis of the request, and the availability of resources, but also to the continual re-contextualizations that such a problem requires. The shifting of observation from the syndrome to the construction of possible realities necessarily entails repeatedly violating the concept of “therapeutic context” itself. Care continually enters “mental and physical places” that are seemingly remote from our habits of mind. This implies our readiness to accept continuous hybridations and contaminations and the acquiring, on the part of the concept of therapy, of the meaning of “itinerary”. The ability/possibility to develop a project goes through these steps, where the social, the cultural and the psychic selves interact with one another creating new arrangements, new discoveries, and new orders, not only individually.

CONCLUSIONS At this point, the following questions arise: “What does therapy mean in such a complex and composite framework?”, “What does 'treating' mean in today‟s world?”, and “What are the borders of what we call 'care'?” In the past, the alleged neutrality of science justified “non intervention”. Whenever socalled social issues arose, intervention was deemed impossible and undue: a “neutral” and detached attitude was considered as the only correct one. Then, the student protest attempted to question a certain way to look at and make science. Accordingly, walls were pulled down and ideologies considered too narrow were abandoned. Though updated in the light of the latest developments, the question to be answered is still the same: what stand is to be taken by the scientist, the clinician or the worker in the face of certain phenomena which are currently upsetting humanity (which is not only that of the West, whose gap with the rest of the world increasingly widens in terms of wealth and standards of living)? Migration, the material and psychic poverty of the old and the new poor, marginalization, and cultural uprooting are phenomena which are not only social. Would an adjustment of therapeutic techniques to these specific problems be sufficient (just as happened with American psychiatry which created “folk psychiatry” to better “understand” Indians)? What theoretical/practical intervention is to be chosen by workers who deal with that particular phenomenon which is referred to as “pathology of transition”, “pathology of the transeundi”, or “pathology of the margin”? Someone might wonder what this discussion aims to. Does it aim to extol the other, the different, the poor, the migrant? Is this a sort of psychiatric “neo-Franciscanism” which entails the risk of losing one‟s professional identity? It is definitely not. To find an answer, it is necessary to raise a few questions entailed by the so-called “technical aspect” which often risks to make us loose sight of reality, namely: 1) The difficulty to use certain current scientific paradigms to investigate complex and multiple realities which continuously change. What is culture, disease, care? What is to be meant by “social”? And, most of all, how ready are we to stake ourselves and try different approaches? 2) The holding of prejudices and stereotypes even among the so-called progressive forces which, actually, find it difficult to create a culture mingled with the “other” cultures which they necessarily come into contact with.

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Alfredo Ancora 3) “The social comeback”. How and in what relation to the symptom/malaise? Theory (thought) - practice (clinic) - theory (thought) or reverting to psychology as a fig leaf which hides one‟s private parts described by Gramsci?206 4) The family. New (mixed, reunited or immigrant) and old kinds of aggregation (poor, with multiple problems or under-organized) require openness, flexibility and mobility of thought. They are fundamental to shape habits of mind able to follow new paths across disease meant as the boundary of knowledge. 5) The transition from the sign (symptom) to culture, or rather the cultural system, may come to a standstill if, apart from performing a specific intervention, the worker is not able to make the “leaps” necessary to establish a connection with a dimension which only apparently contains elements “extraneous” to the presenting problem. The therapeutic project could thus become a real attempt to put together the scattered pieces of a story, and the story begun with the family could show us how often it is necessary to extend the project to other variables as well as other times and places of knowledge. Does this mean that the social aspect comes back into play? Or is it rather the well-known Batesonian relation between the part and the whole? Is it relevant for the worker to visit the church or the religious community (as was the case with Mircea) that plays a role in a patient‟s story (often non Catholic) and often takes the shape of a “mystical delirium”? Is it useful or necessary to visit Sabrel in her nomad camp? Do we have to extend the meaning of what the cold bureaucratic language of services defines “house calls”, so as to turn them into opportunities for a deeper and wider kind of knowledge?

The family system can become a cultural place itself, able to create meanings. The service given in these cases takes on the shape and the contents of a “social intervention”,207 a way to co-participate in the construction of unexplored routes, a new and unexpected opportunity, the arising of new possibilities and impossibilities. As already mentioned, the consultation/therapy is gradually losing its features as a technique that “merely has to fix a malfunction” to take on those of a wide-ranging encounter, free from any culture-, family- or technique-centred constraint. The word therapy itself often seems being connected less to the meaning of service (the Greek etymology of the word) and more to contexts where routes are already marked and there is little willingness to follow “unclean” and “contaminating” paths. Maybe, in such a place, other meanings and senses could be found. Thinking through such an encounter also means getting ready for moving and tottering across an uneven ground acknowledging one‟s prejudices and stereotypes, which are often under the disguise of Intervention (the capitalized initial underlines the excessive importance it is often given). It is here, in this particular meeting place of people and worlds, that existential potentials can be realized, in a more or less disguised or unconscious way, and opportunities for creating new plots are found. During these encounters the plot is written and rewritten together, resulting in a story with possible mistakes and stains, and open to all “natural languages”, that is, related to flesh and blood. This orientation could help make care regain its meaning of “social process”, a process generating interactions, free of all the 206 207

Gramsci, A. (1996). Prison Notebooks. Vol. 2. Ed. and trans. J. A. Buttigieg. New York: Columbia University Press. (Originally published as: (1975). Quaderni del carcere. Vol. II. Turin: Einaudi.) “Research on family is, as all scientific research, a social practice performed by individuals who belong to a well-determined cultural context” (Fruggeri, L., Famiglie. Rome: Carocci, 1998, p. 29).

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ideological waste that has been weighing it down for a long time and, thus, able to recover its shine, that is, to become a human encounter208 with human systems, which cannot do without meta-psychological elements! It becomes an itinerary, able to use all its emotional-sociocultural potential, which shall not be turned into a merely technical context, safe from “slipping”. Wandering off the subject and off the context is certainly welcome, provided it helps us make treatment “be with, be in and belong to the world” within a self-reflecting process.209 The problem also concerns another aspect: identifying the levels that are activated during an encounter, which, at this point, involves no longer two culturally and socially different entities, but a mind pattern and its products. We could imagine that the intervention is more similar to an operation to make, a conversation to start, on a difficult issue, a “metalogue” (as Bateson would put it), which implies the risk of getting lost and, yet, also coming to know other worlds and ways of connection. I have already underlined that “a room”, that only allows a fixed way of thinking, is no more adequate. Indeed, this is a narrow and constraining concept. We need to acquire further knowledge to create and co-create new contexts, different habits of mind, so as to be able to face new phenomena such as migration, issues concerning refugees fleeing from wars not so far away from us, and so forth. We have to take into account new relational modes to create wider opportunities for exchange, wider silent spaces, where silence is not only to interpret but also to listen to as the rhythm of words, oases of our minds where we can put together spells devoted to daily routine and theoretical abstraction, the testing of new asymmetries and the implementation of new intuitions… It is high time the mind “went for a walk”, looking for fanciful curiosities and new aggregations. Aspiring to a “relaxed mind” means allowing oneself to make breaks, interrupting a rhythm which has turned into a refrain and “merging into one of those rare spells of grace and thoughtlessness that Hegel called the „Sunday of life‟, spells of joy, dissolution of the centre and enjoyment of forms of desire, rather than forms of show.”210 I have already hinted at the difficulty of thinking in terms of “decentralized observation” in relation to the phenomena to observe – phenomena that we almost wish to “possess”, according to an increasingly pervasive and all-embracing culture, without questioning ourselves, re-aggregating ourselves on the basis of new ways of thinking/acting, and listening to peripheral needs. In this framework, the well-known “encounter with the other” might become just an encounter with another thing, another object, an umpteenth experience which “has” to be gone through, rather than an opportunity to write new texts, discover new sounds, by rereading music scores that we may have thought to have already played. Our journey across, our transcultural thinking, can become a means to follow the patient‟s (and his family‟s) narrative plots, in the awareness that the sense of speech lies in the symbolic world of the culture the subject belongs to (Bruner 1991). 208

On this issue, that is re-humanizing a kind of society which seems made up of objects rather than persons, White writes: “In Western societies, objectifying practices which tend to 'thingify' persons and their bodies are very pervasive” and he adds that persons are constructed as objects and are encouraged to relate to themselves, their bodies, and to others as if they were objects, which means stiffening and formalizing persons. See: White, M. and Epston, D. (1990). Narrative Means to Therapeutic Ends. New York: W. W. Norton and Company. 209 Ancora, A. and Fischetti, A. (1987). Psichiatria come scienza riflessiva. In Tamburini, P. (ed.), Gregory Bateson, maestro dell’ecologia della mente. Bologna: Federazione Università Verdi. 210 de Martino, G. Introduzione. In Lapassade, G. (1980). Saggio sulla transe. Milan: Feltrinelli.

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It is likewise a new journey into the Self, the narrating Self who connects the family, the clinic and the suffering to the possibility to get to new descriptions. The narrating Self necessarily walks across other places, other roots, other stories to attempt to give dignity, a sense and a meaning to people rather than diseases, to human beings who are, also, “human becomings” (von Foerster). Accordingly, in this framework, the issue is not misrepresenting the therapist‟s function and task, by considering him as a sort of social worker, once he has lost his specific competence. The perspective is not technical, but “mental”: it concerns the widening of horizons, reaching a place where consensus evolves and where reality is built, maintained and changed (Sluzki 1999). The new attitude involves the ability/difficulty to decentralize, to give up the “therapy-centred” stance that often makes the views of ourselves in the world too rigid and leads to the prevailing of prejudices and schematisms, a real standstill in the development of multifaceted, polycentric and multiple potentials inherent in all living system. As Heinz von Foerster wonders, maybe it’s high time we came to know the “ourselves” that we would like to put into relation with the world? Every journey, every movement, every transformation, every bet is nothing short of a difficult and tiring attempt to get to know oneself. We wonder with Novalis (1976): “Where are we going?… Always home”…

ACKNOWLEDGMENTS In a certain way, writing is setting down on a paper images and emotions lived through every day. The lines that follow are the clear expression of this concept. Indeed, they are its natural consequence. In this book, curiosity risks (perhaps) turning into conceit whenever I attempt to pass my observations onto readers. Actually, my only and true aim is an invitation to reflect on and discuss about the old and new themes that I shall dwell on. Evidently, this journey of mine has not been a “solo voyage”: it was accomplished with the help of many mates. Mentioning all of them is a demanding task. I shall start from my teachers, who, by dispensing their thought, have awakened inside me, as a student, the interactive energies of “deutero-learning”211 (“learning how to learn”) – as taught by Gregory Bateson – necessary to add new strength to the spur to meeting with the ones of them who are still alive. Clearly, making a list of all those who, though different in level and background, have been most important to me, means recognizing the role that each one of them has played all along my way, no matter how long our mutual relationship. First of all, I thank Bruno Callieri who, since the Sixties, has been encouraging me to combine the psychopathological world and culture. I am also thankful to Georges Devereux, both for his courses at the École des Hautes Études en Sciences Sociales and our stimulating meetings in his house in Rue Gabriel-Fauré; Antony (it is impossible for me to forget the impressive quantity of books surrounding us); Julian Leff (I edited the Italian version of his Psychiatry Around the Globe); Mara Selvini Palazzoli, Luigi Boscolo, and Gianfranco Cecchin of the Family Therapy Centre of Milan (where I completed my education in systems science); Rosalba Terranova Cecchini, from the Transcultural Institute for Health of Milan; B. G. Burton-Bradley from Port Moresby, who has given me the opportunity to edit the Italian version of his Longlong (“madness” in Papuan); my teachers of anthropology Annabella Rossi and Clara Gallini; poet Peppino Marotto from Nuoro (Sardinia) who, in the Barbagia mountains, has given me unforgettable lessons in modesty and humility; ethnomusicologist Diego Carpitella, who has inspired my research in southern Italy; psychiatrists Giancarlo Reda, Luigi Frighi, and Michele Risso; sociologist Mara Tognetti Bordogna; fiddle player and tarantula healer Luigi Stifani, from Nardò (near Lecce, in the Puglia region); Guillermo Barrientos, director of the Havana psychiatric services; Salvador Minuchin, a master of family therapy; philosopher Franco Voltaggio; Paul Watzlawick, author of “the invention of

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reality”212 (I edited the Italian version). My thanks are also due to Mario Reda, for having given me the opportunity to teach transcultural psychiatry at the General and Clinical Psychology Institute of Siena, to Michel Demangeat and all my colleagues in Bordeaux, who have often invited me to join their training sessions, and Paul Martino, who has shared with me his experience related to his work in Dakar with professor Henri Collomb. Obviously I cannot forget the “other world”, made of those who have allowed me to share in at least one page of their libro de vida and to whom I am much indebted: Don Lino, shaman from Guatemala; Nadia Stepanova, shaman from Buryatia (southern Siberia); Doljin Kandro, an exceptionally wise woman from Ulaanbaatar (Mongolia); doctor Serwadda, traditional healer from Kampala (Uganda); and many others, who have turned our encounters into “non-ordinary” events. I am thankful to all my colleagues and patients from the mental health services of Nuoro, Latina, and Rome, with whom I shared the personal and professional experiences recounted in this book, and I also thank family therapists and friends Anna Lamesa and Umberta Telfner, who have repeatedly read through this book and have given me their very precious advice. I am grateful to the Associazione Italiana di Cinematografia Scientifica [NT: a member of IAMS, International Association for Media in Science], notably Laura Operti, for making available to me the rare video records of Gregory Bateson‟s research, and Giampiero Tulelli, for his help in looking for audiovisual materials. I also thank Maria Gabriella Monti, Paolo Paliani, Angelo Carrera, and Piero Gigante, my late colleagues, who have “participated” in this work. Since this is a book on families, I cannot leave out my own: my grandparents Lucia and Gaetano, who have taught me the difficult art of “listening”; my sister Sara and my aunt Milly; my parents Marta and Aurelio who, with simplicity and love, have taught me never to stop to be amazed before those who are able to convey in a say, made of just a few words, the story of many lives. Finally, I cannot fail to thank my wife Annamaria who has been close to me at all times.

211

This term is a neologism by Gregory Bateson. Cf: Bateson, G. (2000; first printed: 1972). Steps to an Ecology of Mind. Chicago, IL: University of Chicago Press. 212 Watzlawick, P. (1984). The Invented Reality: How Do We Know What We Believe We Know? (Contributions to Constructivism). New York: W. W. Norton and Company.

APPENDIX: WELCOME FORM213 Section A Name Surname Date of Birth Place of Birth Town Country Village Unknown Nationality Residence 1. Legal place of residence: 2. Current place of residence (specify since when): 3. Nomadic: By choice By culture By necessity Religion 1. Practised 2. Not practised 3. The applicant prefers not to talk about this issue

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126 Family of Origin 1. 2. 3. 4.

Applicant's hierarchical position Brothers Sisters Others

Parents 1. Father: Living Age Migrated Religion 2. Mother: Living Age Migrated Religion 3. First migration: When Who Why Family Nuclear Extended Exists Does not exist Exists, but it is illegal Members of the Family 1. Spouse(s) 2. Children Sons Daughters 3. Brothers/sisters 4. Parents 5. Other members

Appendix Cultural Degree 1. School education 2. Forms of traditional culture Section B Reasons for Applying The applicant knew about the mental health service: Yes No Referred by: No one GP Health system Psychiatric services Immigrant welcome centres Friends Others (specify) Diagnostic Hypotheses DSM IV (Diagnostic and Statistical Manual of Mental Disorders, 4th edition) Relational diagnosis Patient‟s self-assessment Therapist‟s assessment Description of the Presenting Problem When it started If the applicant has talked about the problem to someone, specify whom Reaction from the family and/or the community Expectations about the service Facing the Problem 1. If the applicant hadn‟t applied to the service, he/she would have turned to: His/her family His/her community 2. If he/she had been in his/her country, he/she would have turned to:

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128 His/her family His/her community Imagining the Place of Care

How did the applicant expect the place of care to be? Does/Did he/she feel the need for the presence of a member of his/her community or a cultural mediator? Imagining the Therapist What kind of person did the applicant expect the therapist to be? Is he/she the first therapist the applicant has met? Is he/she similar to a therapist/traditional healer typical of the applicant‟s culture of origin? If the therapist the applicant has met with is different from one typical of his/her country of origin, what are the differences? Involvement of the Family and/or the Community Does the applicant think it useful to involve members of his/her family and/or his/her community in the therapy? If yes, who? If no, why? Section C The Migration Process Is this the first time that you have left your country? Why? Is this the first time that your family have left their country? Why? Did you already have any contacts? If yes, which ones? 1. Friends 2. Parents 3. Members of your community Why in this country? Do you have a regular job? 1. If yes, what job? 2. If no, why? Do you want to settle here? Why? Your family:

Appendix 1. 2. 3.

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Have they come here with you? Specify who. Are they in your country of origin? Specify who. Will they reach you here? Specify who and when.

Do you think that they may like the way of living of this country? Would you rather your family remained in your country and you sent them the money? Do you ever miss your country? What do you miss most? If an Italian were asked what he missed most of his country, he would probably answer “pasta” and “espresso”. What would you answer? What is it that you don‟t you like at all or like very little of this country? When you speak to your family, do you talk most of the day, the places you have been to or the people you have met and come to know? Do you think that your family may find it difficult to learn our language and our habits? Do you think that living in this country might mean forgetting about your own culture? What needs to be done to keep one‟s culture in a different country? Can you give a few examples? (rituals, practices, etc.) Do you think it is of any help to be able to attend a place of worship where you can practice your religion? Reunited Couples and Families What member of your family would you like to have with you? Do you think the time your family will be reunited is near? 1. Spouse 2. Parents 3. Children 4. Brothers and/or sisters 5. Other relatives

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Alfredo Ancora Do you think that this experience of migration will change you and/or your family? How? Do you think that those relatives of yours who have remained in your country have changed? How?

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INDEX A abstraction, 14, 71, 121 accommodation, 109 acculturation, 11, 63, 67 adaptation, 59, 60, 63, 66, 68, 109, 111 Africa, 27, 36, 60, 111, 112, 115, 131, 141, 148 age, 23, 56, 61, 69, 75, 82, 87, 108, 113 aggregates, 52, 55, 84 aggregation, 120 Albania, 57, 58 alcohol, 114 Algeria, 50 amalgam, 77, 90 ambiguity, 22, 50, 94, 113 ambivalence, 18, 43, 112, 113, 114 American Psychiatric Association, 8, 135 American Psychological Association, 143 anthropologists, 1, 6, 12, 15, 49 anthropology, 5, 9, 10, 17, 19, 53, 73, 93, 123 anxiety, 11, 46, 53, 73, 99 Asia, 4, 44 assumptions, 64, 94 asymmetry, 46, 94 attitudes, 14, 20, 25, 26, 30, 63, 64, 89, 94 Australia, 10, 11 authors, 1, 8, 14, 44, 53, 56, 92, 96 autonomy, 81, 82, 83, 84, 111 availability, 79, 113, 117 awareness, 4, 44, 46, 47, 53, 56, 63, 64, 67, 71, 95, 121

B background, 1, 12, 21, 31, 42, 61, 68, 75, 96, 111, 123 Balkans, 56, 103 Bangladesh, 95 banks, 44, 113

barriers, 19, 57, 116 beliefs, 35, 44, 47, 61, 62, 63, 69, 70, 74, 75, 83, 86, 96, 117 blame, 73, 74, 100, 104 bonds, 38, 63, 67, 82 border crossing, 96 borrowing, 13, 30 Bosnia, 103 breathing, 47, 115 brothers, 60, 81, 83, 87, 97, 98, 99, 100, 108, 116 Buddhism, 4, 33, 36 bureaucracy, 4, 79

C certificate, 82, 84, 96, 108 channels, 31, 33, 34, 38, 82 chaos, 16, 17, 29, 45, 55 childhood, 87, 98, 107 children, 40, 54, 57, 58, 72, 73, 74, 85, 86, 87, 96, 100, 101, 102, 103, 105, 106, 107, 108, 109, 110, 111, 113, 114, 115, 116, 117 Christianity, 34, 136 City, 22, 50, 68, 72, 137, 140, 147, 148 classes, 79, 82 codes, 32, 42, 47, 62, 64, 89, 90 cognition, 43 cognitive map, 55 cognitive process, 19 cognitive system, 51, 64 collaboration, 22, 81, 125, 143 collateral, 58, 107 communication, 7, 16, 21, 22, 28, 31, 33, 34, 38, 47, 60, 61, 62, 66, 73, 74, 82, 83, 89, 90, 94, 96, 100, 113 community, 8, 14, 38, 46, 60, 62, 82, 83, 90, 95, 96, 97, 98, 99, 103, 105, 120, 127, 128 competence, 20, 75, 79, 97, 122 competition, 11, 115

Index

152 competitiveness, 99, 100 complement, 5, 77 complexity, 29, 55, 95, 105 components, 45, 46, 52, 63, 105 comprehension, 69, 71 compulsory education, 108, 114 concentration, 27, 75 conceptualization, 34 concrete, 8, 29, 38, 62, 71, 81, 82, 98, 112, 113 concreteness, 9, 70 confidence, 64, 115 conflict, 8, 17, 37, 47, 58, 68, 73, 74, 75, 103, 104, 105, 109, 116 confrontation, 6, 15 confusion, 6, 43, 66, 73, 77, 110, 112, 116 consciousness, 13, 26, 81 consensus, 80, 122 construction, 3, 13, 15, 16, 62, 78, 80, 117, 120 contamination, 16, 17, 37, 77, 91, 93, 94 contextualization, 63 continuity, 42, 91, 94, 96 control, 18, 28, 72, 74, 79, 98 conviction, 70, 81 costs, 5, 80, 95 country of origin, 62, 78, 113, 128, 129 couples, vii, 62, 80, 96 covering, 88, 99 creativity, 13, 56, 95, 116 crime, 56, 58, 104 criticism, 8, 50, 81, 85, 91 Croatia, 101 cultural clash, 113 cultural differences, 61, 63 cultural heritage, 7, 62, 67, 87 cultural identities, 37 cultural tradition, 43 cultural values, 62 curiosity, 15, 27, 48, 51, 123

D dance, 1, 40, 41, 42 dances, 40, 43 danger, 15, 37, 102 dangerous behaviour, 102 data collection, 10 death, 10, 11, 35, 46, 50, 58 decentralization, 39 definition, 6, 8, 17, 18, 20, 44, 49, 62, 69, 72, 78, 81, 86, 92, 93, 94 delirium, 5, 47, 120 delusions, 61, 70 detachment, 23, 38, 52, 84

Diagnostic and Statistical Manual of Mental Disorders, 8, 127, 135 differentiation, 1, 19, 63, 84, 96, 98, 112, 113 dignity, 28, 43, 46, 122 discipline, 2, 4, 53 disorder, 8, 11, 16, 45, 46, 60, 62, 66, 68, 70, 71, 72, 73, 74, 77, 93, 107, 112, 114, 116 displaced persons, 78 distress, 32, 33, 36, 45, 48, 61, 74, 83, 84, 115 diversity, 24, 51, 52, 55, 86, 107 DNA, 53 doctors, 31, 35, 41, 97, 103 drawing, 18, 59, 107, 113, 117 dream, 21, 27, 28, 57, 66, 67 dreams, 27, 28, 53, 67, 101 drugs, 28, 41, 56, 84, 85, 86, 90, 99 DSM, 7, 8, 127, 135, 143, 147 DSM-II, 7, 135 DSM-III, 7, 135 DSM-IV, 7, 8, 135, 143 duration, 42, 89

E earth, 2, 25 ecosystem, 35, 88, 90 ecstasy, 26, 30, 42, 43, 45, 46 educational background, 107 elderly, 60 elementary school, 114 emotion, 56, 82 emotional experience, 98 emotional responses, 1 emotional state, 94 emotions, 1, 7, 34, 44, 52, 56, 65, 80, 86, 87, 96, 99, 112, 123 emptiness, 107, 108, 111 energy, 15, 27, 30, 32, 39, 41, 42, 47, 85, 116 engagement, 83, 116 England, 54 enthusiasm, 26, 45, 50, 86 entrepreneurs, 57 environment, 3, 14, 29, 31, 48, 50, 52, 59, 64, 74, 90, 93, 102 epistemology, 7, 15, 19, 20, 55, 92 equilibrium, 75, 83 Eritrea, 107, 108, 109, 111 ethnic groups, 62, 63, 106 ethnocentrism, 2, 25, 49 ethnomusicology, 39, 40 Euro, 57 Europe, 23, 44, 57, 104 evil, 27, 28, 32, 68, 70, 71, 72, 73, 74, 97, 114, 115 evolution, 16, 18, 61, 62, 79, 84, 93, 96, 101

Index exclusion, 3, 19, 111 extinction, 15, 35

F facial muscles, 47 failure, 11, 110, 112, 116 faith, 41, 50, 83 family members, 28, 45, 63, 67, 73, 75, 80, 81, 86, 88, 90, 96 family system, 62, 74, 75, 80, 81, 82, 83, 84, 85, 90, 96, 112, 113, 115, 120 family therapy, 15, 64, 91, 93, 96, 123 fear, 3, 34, 38, 47, 53, 69, 77, 86, 90, 91, 99, 100, 101, 108, 115 fears, 6, 24, 37, 43, 56, 84, 86, 100, 101, 102, 116 feedback, 12, 16 feelings, 2, 45, 61, 73, 80, 82, 100, 102 feet, 27, 29, 104 financial resources, 116 flexibility, 30, 48, 96, 120 fluid, 68, 71 focusing, 1, 23, 30 food, 43, 46, 90, 106 fragments, 14, 35 France, 39, 53, 57, 60, 61, 84, 85, 132, 134, 138 freedom, 19, 20 frustration, 46, 99

G general practitioner, 88 generalization, 82 generation, 87, 113 genre, 38, 92 Germany, 12, 67, 97, 147 gestures, 39, 47, 62, 65, 87, 99 God, 57, 72, 89, 146 government, 20, 56, 91 grants, 23, 116 gravity, 43, 44 Great Britain, 53, 57 Greece, 15, 19, 32, 38, 42 Greeks, 54 grids, vii, 2, 15, 26, 46, 51 groups, 7, 8, 10, 18, 55, 56, 64, 70, 80, 83, 96 growth, 74, 82, 84 Guatemala, 124 guilty, 4, 76, 81, 98 Guinea, 3, 9, 10, 11, 13, 92, 133, 134

H hallucinations, 5, 61, 70 hands, 78, 94, 97

153

harm, 27, 36, 47, 98, 116 harmony, 36, 47, 116 hate, 45, 54, 112 healing, 26, 37, 38, 41, 42, 70, 72 health, 2, 26, 31, 33, 35, 41, 57, 61, 70, 77, 79, 83, 95, 106 health problems, 83 health services, 70 hopes, 64 hospitalization, 27, 73, 83, 85, 88, 99, 102, 114 hospitals, vii, 59, 70, 78 host, 75, 92 hostility, 72, 105 House, 10, 134, 148 households, 57 human sciences, 13, 17 humility, 45, 123 husband, 11, 71, 72, 73, 85, 86, 101, 102, 105, 106, 109, 111, 113, 115, 116

I ideal, 2, 4, 14, 18, 39, 48, 69, 110 ideals, 86 identification, 19, 39, 74, 111, 112 identity, 6, 8, 16, 20, 21, 25, 39, 43, 46, 49, 52, 53, 55, 58, 59, 65, 66, 72, 75, 77, 81, 84, 98, 102, 112, 113, 115, 119 ideology, 80 image, 49, 64, 72, 73, 75, 105, 139 imagery, 102, 105 images, 56, 92, 103, 123 imagination, 8, 13, 19, 55, 56, 78, 95 imbalances, 57, 59 immigrants, 48, 51, 58, 59, 60, 61, 64, 67, 69, 75, 78, 91, 99, 100, 112, 116 implementation, 121 inclusiveness, 8 India, 33, 140 Indians, 64, 119 individualism, 50 industry, 30 infancy, 15, 54 information exchange, 19 initiation, 28, 30, 38, 44, 140, 145 insecurity, 15, 75 inspiration, 30, 39 instability, 100, 112 instruments, 10, 38, 41 integration, 8, 27, 58, 63, 82 interaction, 7, 13, 18, 22, 25, 26, 52, 61, 62, 82, 86, 88, 94, 115, 116 interactions, 7, 22, 37, 59, 80, 83, 84, 113, 120 interface, 18, 20, 66

Index

154 intermediaries, 31 internal barriers, 3 interpersonal relations, 75, 80 intervention, 1, 4, 9, 15, 51, 61, 73, 74, 77, 79, 86, 94, 105, 117, 119, 120, 121 interview, 40, 41, 92 iron, 23, 27 Italy, 1, 5, 12, 15, 21, 22, 23, 40, 46, 57, 58, 61, 62, 70, 72, 82, 91, 92, 93, 96, 97, 99, 101, 102, 103, 104, 106, 108, 112, 113, 114, 123

J Jews, 19, 50 jobs, 108, 114, 116

K knees, 89, 104 Kosovo, 58, 104 Kurds, 56

L land, 18, 39, 43, 48, 49, 76, 82 language, 5, 7, 28, 42, 62, 82, 107, 109, 111, 114, 120, 129 learning, 26, 28, 66, 111, 116, 123 liberation, 42, 50 life experiences, 5 life sciences, 15, 17, 23 lifetime, 30 line, 6, 10, 16, 18, 19, 20, 23, 24, 31, 39, 44, 53, 61, 100, 103 links, 2, 17, 37 listening, 99, 121, 124 local authorities, 90, 102 loneliness, 99, 111 love, 44, 45, 47, 51, 52, 89, 112, 124 luggage, 26, 54 lying, 45, 61, 66

M machinery, 58 malaise, 36, 38, 39, 42, 59, 60, 61, 62, 69, 70, 75, 80, 84, 86, 120 Malaysia, 11 management, 109 marginalization, 70, 119 marriage, 72, 73 Martin Heidegger, 23 mathematics, 13, 23 matrix, 96, 112 meals, 56, 62, 103

meanings, 13, 16, 18, 22, 33, 66, 80, 95, 120 mediation, 32, 73 medical care, 91 melting, 45, 64, 66 men, 1, 11, 18, 22, 28, 34, 41, 54, 55, 63, 69, 92, 112 mental disorder, 27, 61 mental health, 43, 59, 70, 77, 78, 80, 87, 90, 91, 95, 97, 105, 107, 124, 127 merchandise, 116 messages, 69, 73, 100 metaphor, 1, 6, 14, 21, 51, 91 migrants, 1, 11, 50, 62, 64, 144 migration, 14, 50, 57, 59, 60, 61, 62, 63, 66, 81, 92, 112, 121, 126, 130, 142 military, 20, 41, 51 mind-body, 34, 69, 73 mobility, 1, 7, 19, 53, 55, 120 model, 15, 66, 80 models, 24, 62 modern society, 16, 49 modernity, 54 money, 71, 98, 106, 109, 129 Mongolia, 30, 31, 46, 124 Moon, 72 morning, 31, 40, 50, 106 morphogenesis, 68 mothers, 110 motion, 5, 21, 25, 50, 55, 92, 93, 113 mountains, 123 movement, 20, 55, 57, 61, 81, 92, 122 music, 21, 27, 37, 38, 39, 41, 42, 58, 62, 92, 100, 121 Muslims, 30 mutual respect, 26, 31

N narratives, 65 nation, 54, 55, 58 national identity, 58 nationality, 67 natural food, 90 natural selection, 35 network, 10, 12, 38, 61, 66, 75, 78, 79, 88, 102, 116 neurasthenia, 23 neuroleptic drugs, 31 neuroleptics, 87 Nietzsche, 34, 144 Nile, 27 noise, 54 North America, 8 nuclear family, 88 nucleotides, 53 nursery school, 116 nurses, 31, 78

Index

O objective reality, 47, 48 objectives, 82, 86, 113 obligation, 83 observations, 4, 12, 26, 33, 42, 64, 69, 73, 74, 75, 78, 81, 88, 90, 91, 93, 109, 111, 123 Oklahoma, 52, 147 old age, 41 openness, 2, 8, 30, 75, 89, 120 order, 1, 2, 3, 14, 16, 19, 26, 29, 31, 35, 36, 37, 44, 45, 48, 51, 53, 54, 59, 63, 64, 65, 69, 72, 73, 74, 75, 81, 82, 86, 89, 91, 93, 94, 95, 97, 103, 104, 106, 108, 110, 111, 116 organism, 7, 10 orientation, 93, 94, 120 otherness, 24, 25, 53

P Pacific, 31 pain, 29, 33, 35, 45, 60, 100, 111, 115 parameter, 60 parameters, 5, 47, 59, 77 parents, 40, 70, 73, 82, 83, 84, 85, 86, 87, 89, 99, 101, 102, 103, 107, 108, 109, 110, 111, 113, 115, 124 partnership, 27 passive, 43, 83 pathology, 5, 64, 78, 79, 119 patriotism, 54 personal relations, 36 personal relationship, 36 personality, 11, 12, 32 phenomenology, 16, 75 Philippines, 11 philosophers, 1 planning, 42, 79, 116 Plato, 35 poison, 40, 41, 42 police, 41, 103 political ideologies, 50 politics, 1, 84, 85 pollution, 93 poor, 50, 54, 80, 87, 88, 96, 97, 106, 119, 120 poverty, 95, 96, 119 power, 1, 11, 20, 27, 28, 37, 38, 41, 42, 46, 53, 69, 88, 98, 105, 107, 111 pressure, 8, 17, 57, 58, 75 prevention, 57, 58, 79 primary school, 82 prisoners, 57 privacy, 106

155

problem solving, 16 prognosis, 40, 70 psychiatric diagnosis, 60 psychiatric hospitals, 29, 70 psychiatrist, 1, 3, 5, 11, 22, 26, 30, 31, 33, 39, 59, 61, 62, 70, 71, 85, 87, 110 psychologist, vii, 22, 25, 36, 41, 52, 83, 85 psychology, 60, 73, 79, 120 psychopathology, 2, 32, 59 psychopharmacology, 7 psychotherapy, 9, 46 public service, 1, 69, 79, 107 purification, 31 purity, 37, 91

Q question mark, 64 questioning, 13, 45, 59, 98, 121

R racism, 2, 49, 107 rationality, 5, 14 reading, 10, 11, 30, 46, 121 reality, 8, 9, 10, 12, 13, 16, 21, 26, 34, 36, 38, 44, 47, 48, 53, 55, 63, 67, 75, 77, 81, 82, 83, 85, 86, 91, 95, 97, 104, 105, 116, 119, 122, 124 reason, 6, 24, 29, 32, 34, 35, 43, 49, 56, 74, 78, 101, 104, 107, 109, 110 recall, 58, 87 recalling, 82 reception, 39, 60, 62, 77, 81, 103 recognition, 24, 28 reconciliation, 35 reconstruction, 58, 65 reference frame, 107 reflection, 1, 4, 32, 33, 37, 73, 79, 88, 105 refugees, 51, 56, 58, 67, 78, 121 region, 18, 20, 22, 27, 36, 39, 40, 51, 56, 58, 70, 71, 72, 74, 87, 123 rehabilitation, 107, 110 relationship, 1, 2, 5, 7, 8, 13, 19, 21, 25, 26, 28, 29, 31, 32, 33, 34, 35, 45, 46, 47, 49, 51, 52, 53, 60, 61, 62, 80, 85, 88, 101, 105, 106, 111, 112, 116, 123 relatives, 3, 73, 89, 109, 129, 130 relevance, 12, 13, 66, 79 religion, 14, 22, 23, 33, 39, 41, 46, 55, 69, 73, 74, 76, 84, 97, 99, 115, 116, 129 repression, 31, 113 resistance, 21, 30, 63, 75, 82 resolution, 68, 101

Index

156

resources, 45, 48, 61, 63, 64, 79, 84, 88, 94, 96, 116, 117 returns, 63, 112 rhythm, 38, 121 risk, 1, 3, 4, 6, 8, 9, 15, 33, 34, 35, 37, 44, 45, 47, 50, 55, 61, 80, 84, 92, 113, 119, 121 Romania, 97, 98, 99, 100, 106 Russia, 132

S Samoa, 11, 143 Sarajevo, 21, 103, 140 Sartorius, 145 satisfaction, 45 Saudi Arabia, 62 schizophrenia, 1, 26, 45 scholarship, 10 school, 2, 10, 11, 24, 31, 33, 50, 77, 81, 82, 84, 106, 108, 109, 110, 111, 114 scores, 121 search, 4, 6, 15, 16, 20, 23, 25, 35, 49, 56, 70, 112 searching, 32, 91, 95 Second World, 20 security, 62 self-assessment, 127 self-confidence, 86, 88 sensation, 70 sensations, 28, 30, 42, 44, 45, 63, 70, 78, 94, 101 senses, 68, 120 sensitivity, 52 separation, 19, 111 Serbs, 103, 104 shade, 14, 21, 34, 65, 77 shamanism, 30, 33 shame, 16, 52 shape, 8, 14, 32, 44, 50, 52, 55, 58, 74, 77, 80, 94, 99, 100, 116, 120 shaping, 25 sharing, 1, 7, 36, 44, 67, 70, 87 shelter, 56, 62 Siberia, 1, 30, 31, 33, 46, 124, 141, 148 signs, 8, 32, 35, 39, 40, 55, 66, 78 Singapore, 144 skills, 31, 32, 44, 45, 58, 63, 65, 75 skin, 19, 23, 26, 51, 56, 116 social change, 8 social class, 63, 67, 79 social context, 94, 112 social environment, 8 social group, 35, 44 social network, 116 social phenomena, 10, 64 social rules, 48

social sciences, 17, 19 social services, 102 social structure, 10, 18, 88, 93 social workers, 78 socialization, 47 soil, 94 solidarity, 1, 46, 56, 57, 58, 60, 86, 99 space, 5, 6, 17, 20, 22, 23, 48, 52, 53, 60, 63, 65, 66, 69, 74, 83, 86, 94, 95 space-time, 74 specialization, 96 spectrum, 106 speech, 30, 36, 82, 87, 121 spirituality, 4, 33, 36, 37 sports, 113, 114, 116 standardization, 55 standards, 12, 18, 119 statistics, 52, 95 stereotypes, 1, 30, 102, 119, 120 strain, 45, 85, 99, 100, 105 strategies, 2, 86 strength, 20, 50, 98, 114, 123 stress, 5, 23, 55, 57, 64, 109 subgroups, 10 subjectivity, 16 suicide, 83, 114 summer, 88, 100, 110, 114 superiority, 12 supernatural, 11, 68 Switzerland, 97 symbolism, 61 symbols, 2, 21, 27, 44, 46, 78 symptom, 7, 60, 61, 63, 70, 74, 75, 78, 84, 120 symptoms, 2, 7, 61, 62, 75 syndrome, 11, 32, 67, 73, 105, 117 synthesis, 20

T targets, 81 teachers, 37, 123 team members, 97 technician, 46, 65 telephone, 11, 57, 102 television, 52, 56, 67, 71, 103, 104 temperature, 86 tension, 18, 21 territory, 17, 20, 25, 61, 70, 71, 75, 77, 79, 94, 104 theoretical assumptions, 2 therapeutic community, 48 therapeutic encounter, 1, 5 therapeutic process, 6, 47, 48, 74, 94, 97, 103 therapeutic relationship, 9, 30 therapeutics, 96

Index therapists, 1, 15, 33, 35, 45, 61, 75, 77, 96, 102, 124 therapy, iv, 3, 13, 15, 35, 40, 45, 59, 63, 64, 66, 70, 72, 77, 79, 92, 93, 95, 96, 110, 117, 119, 120, 122, 128 thinking, vii, 2, 10, 12, 16, 17, 27, 36, 37, 51, 65, 66, 68, 69, 77, 90, 92, 93, 96, 121 thoughts, 1, 2, 6, 19, 22, 24, 26, 27, 62, 74, 105 threat, 38, 57, 64 threats, 52, 61, 105 threshold, 20, 21, 22, 23, 24, 32, 39, 53, 65, 92, 93, 105 thresholds, 16, 61, 64 tradition, 18, 33, 43, 106 traditions, 31, 36, 37, 40, 42, 43, 63, 82, 93 training, 1, 96, 124 traits, 17, 26 transformation, 3, 6, 15, 45, 68, 122 transformations, 21, 44, 92 transition, vii, 2, 21, 42, 44, 64, 66, 78, 91, 98, 119, 120 transitions, 15, 44 translation, 37, 44, 142, 147 transmission, 38 transportation, 54, 87, 89 trust, 37, 71, 82, 90, 98, 102, 103, 110, 115

U Ukraine, 97, 99 uncertainty, 61, 75 unemployment, 15, 56 United States, 8, 20, 53 universality, 59 universe, 2, 25, 30, 32, 33, 42, 43, 46, 51, 66, 75, 78, 102 universities, 77 updating, 8 urban areas, 80 urbanization, 64

157

V victims, 78, 104 village, 3, 27, 28, 29, 72, 87, 97, 98, 112, 114 violence, 34, 106 vision, 35, 41 vocabulary, 58, 65, 67

W walking, 47, 87 war, 20, 27, 31, 41, 51, 56, 58, 66, 104 weakness, 1, 82 wealth, 11, 119 wear, 11, 87 welfare, 23, 95 welfare economics, 95 welfare state, 23 western culture, 32, 51 winter, 87, 88, 99, 106 withdrawal, 32 witnesses, 8 women, 28, 41, 63, 69, 78, 105, 107 workers, 24, 31, 35, 38, 44, 47, 48, 74, 78, 80, 91, 93, 95, 96, 101, 107, 119 working hours, 116 World Bank, 95 worry, 102 writing, 13, 14, 19, 44, 66, 123

Y young women, 58 Yugoslavia, 101, 103

Z zoology, 10