rMH 14, 2010, 11-14
Christian's smile. Considerations on disability, beyond clinical issues
In this article, the difficulties of relation and communication with disabled patients are analysed through three cases. The unexpected disability at birth, the difficulty of interpreting the personal experience of disabled patients and the terminal phase of their life are the events and themes that influence the professional experience of pediatricians. In fact, it is not much in the clinical domain, but rather in the relational and communicational sphere that the pediatrician faces a complex and difficult challenge. The tools for coping with medical problems are provided by modern medicine, whereas those for dealing with relational and communicational ones are to be found within personal and professional experience.
rMH 14, 2010, 15-23
Medical treatments and the sense of life in cases of handicap
This article contains a summary of the most important stages in the life of two parents and their disabled son. From birth, the many admissions to hospital and surgery for eye disease were but parts of a continuous and never-ending process of adjustment. Pain and the stress related to the uncertainty of the future are some of the main themes of this article, as are the positive aspects of the story, i.e. how the family managed to establish a good relationship with the doctors and the other assistants who helped them for more than thirty years. The good relationship between the family and the people who helped them most allowed to stabilise the physical and mental conditions of the son and to turn him into a happy man.
rMH 14, 2010, 24-29
When handicapped children grow old. What happened to my brother
Mentally disabled people are particularly vulnerable to early ageing. The author of this paper tells the story of his brother, from birth to the insurgence of severe schizophrenia at the age of forty, against its familial environment. Each of us is strongly influenced by familial relationship, and this is even the more important in the case of mentally disabled people, who tend to become the focus of strong and complex relatioships of dependence, as is testified by the present case.
rMH 14, 2010, 30-41
The concept of “double diagnosis” applied to handicapped people first appeared in specialised literature at the end of the Eighties in order to formalise the presence of psychiatric disorders as well as mental retardation. Until then, classic psychopathological symptoms had been considered part of the “mental retardation” disorder. Although they were not ignored, neurological parameters were not included at all in this double diagnosis – they were considered a different matter altogether. This paper, which contains an Italian translation of part of the book Handicap mental: approche transdisciplinaire
(Masson, 2009), suggests a “triple approach” to the handicapped patient: somatic
or, more specifically, neurological; psychiatric
, in case of behavioural disturbances such as depression, anxiety, psychosis etc., and psychopedagogic
. The paper highlights the risks of incorrect diagnosis and mistakes linked to the lack of coordination between the three approaches, and stresses the importance of interprofessional collaboration.
rMH 14, 2010, 42-51
Adult disabilities: considerations on the connection between care relationship and its humanization
In modern society adults with disabilities and elderly people constitute a universe apart – they seem to belong to another planet. Mental disability, in particular, often appears as incomprehensible if not dangerous. The present structure of our societies, the predominance of capitalistic economy and the consequent primacy of efficiency and productivity, push these categories of citizens aside.
Economy and social policies often do not invest in providing care and assistance for adults and disabled people, which are left to healthcare workers and social services. The key words for people training to provide help and assistance for these vulnerable subjects are: autonomy, interdependence, trust and responsibility.
rMH 14, 2010, 52-55
Rights of psychiatric patients: antinomies, involutions and future prospects
The (sometimes unnecessary) use of measures of physical containment is described by the author as the emblematic aspect of the antinomic (and ideological) nature of the relationship between psychiatric procedures and the constitutional rights of patients in a democratic country. The subject of limiting the deciding power of the most vulnerable and defenceless people in psychiatric hospitals and retirement houses is not new. It is at the centre of a long debate involving psychiatrists with different professional cultures and ethics from every part of the world.
The author criticises the laws – in force in Europe and in the Swiss Confederation – which judge the use of containment measures in psychiatric institutions too prudently and do nothing to reduce their use. He offers a more favourable opinion on the situation in the Canton Ticino which has, over time, changed. A new interdisciplinary legislation – the “sociopsychiatric law” has been adopted and has succeeded in turning new ideas into rules.
rMH 14, 2010, 67-74
Risk in medicine and the life sciences: a few ethical and (alas!) political considerations
Risk has had many faces through the history of medicine and technology. The dictum primum non nocere
was quite appropriate in an age were doing harm was easy and doing good difficult or impossible. The therapeutic revolution put medical benefits on an equal footing with risks, leading to risk – benefit analyses, soon complemented by the additional variable of cost. Modernity also conquered risk by making it an actuarial and objective notion. Nevertheless the age of large scale technologies has made risk analysis more complex and more controversial. Subjectivity re-enters the picture, especially when considering risks of enormous magnitude but very low probability, or when technology’s benefits accrue to some people while the Damocles’ sword of risks hangs over other people’s heads. Recognizing the subjective element of risk is necessary, but there is nowadays an unfortunate trend towards plainly relativistic views. The example of the precautionary principle shows the decay of an initially reasonable prudential attitude in the face of scientific controversies, towards a relativistic view that makes technology assessment utterly vulnerable to ideological manipulation.
rMH 14, 2010, 75-79
Severity scores in intensive medicine
This paper deals with the problems related to prognosis in intensive medicine, focusing on the statistical tools for evaluating the chances of recovery or death of patients, i.e. severity scores. The authors discuss the clinical and philosophical bases of these tools and the implicit epistemological and ethical assumptions underlying them. This is the first step to explain the problems they cause at a methodological and clinical level, especially with regard to the limits of their individual prediction capacities and the reification of risk. Severity scores are not epistemologically or ethically impartial tools, because they are implicitly linked to values. It is important to make values explicit, in order to avoid the inappropriate conditioning of hopes and decisions linked to the continuation or the discontinuation of specific therapies.