Three fresh impressions from my week in Trieste

I am sitting here in Schiphol International,  on a five-hour layover heading back home to Los Angeles.  My team and I just spent a fast-paced week in Trieste – reconnecting with old friends and  forging new connections.  We were here to do the advance planning for a study visit that Heart Forward is planning for 20 people in October of this year.

Before the press of LA-life engages me, I wanted to share three observations I walked away with that help to underscore the unique corner of the world that is Trieste. 

1.  Radical hospitality is accoglienza and accoglienza is radical hospitality.

My challenge in returning from previous trips was to try to convey – in our language – what I witness time and time again in the mental health system in Trieste.  I landed upon accoglienza (which is the name of this blog-site) and I define it as:

·       We see you.

·       We hear you.

·       You are safe here.

·       Your voice matters.

Let me share just one of many examples I witnessed of accoglienza this week.  When I was visiting the psychiatric unit at the central hospital and briefing the staff about the upcoming October visit, one of the patients wandered in.  He is in his early twenties; had shorts on and no shoes.  He is facing numerous challenges at present and instead of being shooed away from the office, everyone said hello to him.  (“We see you.”) 

They introduced him to me and said I was a visitor from Los Angeles.  One of them asked, “don’t you speak English?”  He did and I started to engage him.  (“We hear you.”)   I used the Hollywood calling card, which gets attention and we bantered a bit about celebrities, sports and how he learned English in a British school. 

There was no rushing; we talked as long as he had the energy to do so.  (“You are safe here.  Your voice matters.”)  I learned more about his story later, but I was told that our little conversation represented the longest anyone had been able to engage with him.

And this leads me to the second observation.

2.  People trained in conventional clinical disciplines may have to unlearn what they’ve been taught.

The vision and influence of Dr. Franco Basaglia cannot be underestimated in the history of how the mental health services in Trieste evolved.  And, his imprint on Italian law is linked to the reference to Law 180 (passed in 1978) as “Basaglia’s Law.”  The “elder statespeople” in Trieste today – psychiatrists and psychologists who are now in their 70’s -- speak fondly of the early days in their career when they migrated to Trieste to be part of the revolution that Basaglia was forging.  (See photo above of the young generation who flocked to work with Basaglia.)

 Basaglia’s approach – to engage one-on-one,  entering into horizontal relationships with the people entrusted to his care,  and to set aside the clinical techniques taught in medical school which revolve around diagnosis, medication and talk therapy – was (and still is) revolutionary and uncomfortable to those who are trained in conventional ways.

And, in the United States, no psychiatrist, psychologist or even a licensed clinical social worker is compensated or rewarded to spend the time necessary to truly assess the context of a person’s life under their care (e.g., living situation, family dynamics, physical health, how they spend their time and life aspirations).

And that leads me to the final observation.

3.  Casa. Lavoro. Socializzazione.

In three separate conversations this week about the ethos of the Trieste approach, the “three pillars” of a healthy life were shared.  From meetings with a retired psychologist, a practicing psychiatrist and a young woman studying to become a psychiatric rehabilitation specialist (similar to occupational therapy) we were told in no uncertain terms:   “We must pay attention to these pillars -- home, work, community.”

It struck me that this framework is gaining traction, even in the U.S.  In Dr. Tom Insel’s book, Healing:  Our Path from Mental Illness to Mental Health, he reveals that relatively late in his career he grew to appreciate the critical importance of social supports for people with mental illness, not just clinical supports.    On his website he says that the “path to healing, built upon what he calls the three P’s (people, place and purpose) is more straightforward that we might imagine.”

And, indeed, in the Hollywood 2.0 state-funded mental health pilot which is currently underway, People, Place and Purpose undergird the framework for the innovative services under development.

A planning lunch with Elizabetta Naviglio of La Collina Social Cooperative. L-R Fabiola Vilchez, Elisabetta, Kerry Morrison and Evangeline Lee.

There is more I want to write – especially with respect to the commitment to recovery that is evident in Trieste and the notion that people have to have hope that they can recover and reclaim their life  -- but that will come later.  The plane is boarding.