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Perhaps mental health is the opposite of madness. My own view is that 'madness' means taking a great deal or too much or even everything too seriously. Thus, if mental health is the opposite of this, it can only be the exercise of the meaningless, of vacuity, in short, complete bad faith and the obtuse flatness of inertia.

Fortunately, between these two extremes there's a reasonable dose of anxiety which nearly all of us carry within ourselves, as well as a reasonable dose of obtuseness and mendacity which enables us to maintain a precarious balance. A balance which is perhaps not wholly desirable and which is mediated to a greater or lesser degree by a social contract which, measured in goods and products, constitutes our commercial training that predominates over all and determines who and what is included or excluded. The real issue is thus when and why the production of shared doing and feeling is possible, credible and dedicated to some other end than that of goods and merchandise. Social realism taught us that beyond the commodity there is deception, lack of freedom and the institutionalisation of an abstract ideological power which becomes tangible and pervasive violence: ie. the State.

It is possible to think of mental health being present when a person can live with others, communicate through language, express themselves through acceptable differences and constitute themselves in a partly unique, partly general way. Constituting oneself and being constituted on the fine line of inclusion/exclusion, that limit where others can contain you and you can contain yourself while finding a shared sense and practice, an interrelated project.
If it is probable that only language can save us, then it is equally probable that in madness there is, if not an explicit choice, then certainly an implicit acceptance, a continuous cossetting of the self, a self-seduction and prodding of the 'dente dolente', the infected tooth, an extreme identity in which the Other weighs even more decisively upon one's own destiny. If only the Other can save you from yourself, can keep you in check or perhaps push you beyond a limit and cast you, abandoned and shipwrecked, completely detached and relationless, then we should speak only of this.

This is what I know, basically. But I also know that when one goes beyond this limit, the social contract results in someone with certain professional capacities and responsibilities being designated to deal with you. And this is when we see the daily – or possible daily results of such an intervention: how exclusion can be confirmed and a state of 'non-health' judged and an illness objectified (though we should bear in mind that it is probably better to be 'ill' than to be considered possessed or similar and that – though here a healthy scepticism is obligatory - it is likewise better that a so-called doctor takes care of you than a so-called exorcist and that a hospital is perhaps better than being confined to the edge of the village). The issue is whether in this situation it is possible to rebind the strands of inclusion or if this situation can only worsen and these professions and services only increase the often irreversable and inevitable burden of exclusion.

If health and illness are often clearly co-present in body and spirit, but it is difficult to specify where one ends and the other begins, we are left with the sensation that words are utterly inadequate to describe what is really happening here. This inadequacy of words is due to their rationalising nature, which is incapable of dealing with the unique nature of the irrational. Using language to enter into madness is like using a yardstick to measure a liquid. But is language therefore suited to speaking of mental health, and the elements which make for a healthy mind? And health in whose eyes? The eyes of those who observe and judge me, or my own eyes, which I turn on my self both asleep and awake in order to confront the dangers that daily threaten me and preserve my own health?

In any case, is the secession from the world which is incorporated exclusion, interiorised and self-validated aggression, the extreme sign of madness or the ultimate residue of mental health, defended in extremis and against all evidence? (We need to question ourselves concerning this strange fate: if defending ourselves against 'the competition' is really as 'fatal' as it seems).
But the real issue remains if there is any sense in continuing to ask ourselves what mental health/illness is within a social organisation that defines both. Near-total social control results in the presumed mental disorder and evaluation as to person's lack or loss of mental health and resulting shift of responsibility from the family to the social or healthcare system being generally precocious and immediate. Mental health could be viewed as being free of competition, of the need to produce more and better, of the risk of exclusion due to an inability to adapt to the laws of the marketplace (which can include knowing how to fish, hunt, knowing something about literature and theatre, being happy and witty, knowing how to sing and dance, being full of initiative and fantasy, a wine taster, erect and up to date, computerised and muscular and, in any case, the producer of whatever commodity happens to be in vogue). Mental health could be the infinite diversion of finally recognising one another as being all diverse and therefore not unequal (I don't know if 'diversity' and diversion' have the same root or not: I like to think they do and that's good enough for me). What establishes in real concrete terms this lethal equivalence between mental health and uniformity if not our fear of losing ourselves due to the non-recognition by others? Even literature, art, food, poetry and theatre have become mere consumer products, topics for useless conversation like that concerning beauty creams and designer fashions. Thought as such is no longer recognisable; at best it is the object of irony given the transformation of the world into an empty concept without either men or ideas. If the only project which is shared is that of development (and consumption), the indicator for mental health will be found there or, at best, in the little house in Tuscany with its vegetable garden and perfumed peas, and never where the effort to live manifests its risk and limits, reveals man in his infinite misery, while still assuming the burden of that misery.

All this is quite obvious and yet remains unacknowledged by 90% of mental health professionals and their practices, their 'production'. The 'psy' sciences are elsewhere and organise thoughts, models, practices and concepts of a completely different kind, superimposing one author over another in a long and endless monologue, a powerful soliloquy because underpinning corporations of power-knowledge, merchandise which accumulates and capital which reproduces itself, unverified, gratuitous, for the most part self-referential, intangible for any sort of crossed consensus. Psychiatry was (and still is in many places) a sort of instrument of terror understood as the annihiliation and attribution of an intolerable identity.

'Basaglian' therefore means thought-with-sensitivity (virtually impossible to find by now), acting according to a minimal ethic, the decent practice of institutions and institutes, an action endowed with that minimum of criticism regarding the idiocy of instituted science in an equally idiotic society which finds its apogee in forensic psychiatry. Basaglian means deinstitutionalising prejudice, suspending judgement, taking oneself seriously and thereby, perhaps, finally breaching the wall, in that anxious desire for democracy which, by reducing obligatory bad faith, becomes our only defense against madness.
Can we allow ourselves independent projects, and a partner in this, accomplices here and there, in order to construct with others a sentence of which we knew only a couple of words, someone or something that doesn't tire of your deformity. And if we had the means of creating the Other as value? Perhaps then, we (psychiatrists) will have finally begun to do our job. Though even then it will be too late.


(From: Franco Rotelli, "Ma la salute mentale che cosa è", in Communitas n. 12 /2006)

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