BOOK REVIEWS, NOTES AND COMMENTS
Guarire si può: persone e disturbo mentale
già Istituto Superiore di Sanità, Rome, Italy. email@example.com
Izabel Marin, Silva Bon
alpha beta Verlag; 2012.
ISBN 978-88-7223-200-2. 15,00.
[Recovering is possible.
Persons and mental disorders]
La vita è un brivido che vola via
è tutt'un equilibrio sopra la follia
forse la vita non è stata tutta persa
forse qualcosa s'è salvato!!(a)
Vasco Rossi, Sally
Le vent se lève! ... il faut tenter de vivre!
L'air immense ouvre et referme mon livre(b)
Paul Valéry, Le cimetière marin
(The graveyard by the sea)
Not a long time ago, a terzetto of well-known Italians - the psychiatrist Peppe Dell'Acqua, the journalist and essay writer Nico Petrella, and the philosopher Pier Aldo Rovatti - started an interesting series of monographs entitled "180"; i.e., the number of the 1978 Italian law which prescribed the phasing out of psychiatric hospitals, the creation of small psychiatric units in general hospitals for the short-term care of acute patients, and the development of community Mental Health Services (MHSs). The book in this series reviewed here, by Izabel Marin (a social worker who came from Brazil for a period of training in Trieste's MHS, but ended up taking root in the Julian city) and Silva Bon (a historian with a difficult personal history of mental disorder ending up in recovery), is of considerable interest from both a theoretical and a practical viewpoint. In fact, it provides a thorough analysis of recovery processes in patients with severe mental disorders, who have long been considered as incurable and therefore were often hospitalized for long periods, or even for the rest of their lifetimes.
The first part of the book is devoted to a comparative analysis of community mental health experiences aimed at maximizing the probability of patient recovery, which have been conducted over the past decades in different countries by groups led both by professionals and by non-professionals after their recovery. These precedents, as well as the authors' direct experience, clearly show the role of a variety of factors in favouring, or viceversa preventing, recovery. These factors interact in specifically different ways in different subjects. For example, the effectiveness of a person-to-person support (from either MHS personnel and/or others) or of a group support varies from subject to subject. This literature also shows the need for expert and cautious help in the attempts to re-establish disrupted family and social relations; to recruit resources which can contribute to the maintenance of pre-existing work activities or to findin finding alternative ones; to overcome a variety of personal "handicaps", ranging from phobic-obsessional tendencies to extreme bashfulness, from persecutory fixations to excessive preoccupation to be a nuisance to others etc. The common denominator in this infinite variety of individual needs is the joint effort of patients and MHS staff to re-establish self-confidence, to promote empowerment, and to boost the capability of coping with the ups and the downs of symptom severity. The importance of the role of "conventional" tools like drugs or psychotherapy is far from being discounted in this context; but, the benefits of the use of these tools are maximized if they become part of a covenant between therapists and patients, in which the latter gradually acquire the capability of making for themselves a variety of critical decisions. In a few words, as is emphasized in the excellent Introduction by Roberto Mezzina one of the leaders of the Trieste MHS staff, specifically involved in the work on recovery processes "... recovery does not necessarily mean clinical cure, but rather emphasizes the journey made by every one to build a life beyond the disease ..." (p. 13). The variety of processes involved is clearly and fully confirmed in the second (narrative) section of the book, which includes a lucid autobiographical account by the second author and four interviews with subjects who recovered with changing fortunes from severe mental disorder. A summary of these 100 pages is obviously impossible.
The reader should be reminded at this point that the Italian vocabulary lacks some words which are essential for important distinctions in the field of health and disease. The best known example is the difference in English between illness (or sickness), the subjective feeling that something is going wrong in the body and/or in the psyche, and disease, the specific pathological condition as defined in medical terms - Italian has only malattia, disease. (Incidentally, psychiatric disorders, after centuries of research on various aspects of the problem and incessant fierce conflicts between various "schools", are still far from fulfilling the nosographic and etiopathogenetic criteria required to reach the "status" of medical diseases; therefore, it seems more correct and heuristically valuable to consider them as illnesses rather than diseases). Medical anthropologists have introduced another term of special significance in the case of mental disorders - predicament - to indicate the type and severity of the difficulties created in the patient's life by one or the other pathological condition. Most of this book is, in fact, about the subjects' predicament and its changes in their journey towards recovery, but the term cannot appear.
An equally important distinction is the one between recovery - again a term without an appropriate Italian equivalent - and cure (healing) - hence the problem with guarire in the title, which is not intended to mean healing or curing, but recovering. Recovery is not the same as remission, a term which indicates an improvement, but also implies that the patient is not healed and that one or more relapses have a substantial probability of occurring, often at unpredictable intervals; nor the same as cure, which indicates that a disease has come to an end for good, either as part of its "natural history" or as a result of a specific effective therapy. Such a lack of appropriate terms contributes to the creation of cognitive "black holes" with adverse effects on practice; namely, considering illness and disease as one and the same thing, and ignoring the important fact that recovery can occur short of cure.
The third part of the book is devoted to an accurate critical analysis of the information provided in the previous one by the patients, aimed at refining and integrating the know and the know-how discussed in the first part. The titles of the sections in the chapter "What do the patients with an experience in recovery teach us?" deserve to be mentioned, since they provide a fair indication of the intermediate steps between initial disintegration of the self, viewed as a metaphor of suffering, and the growth of hopes and expectancies of improvement: facing the "wall" which blocks communication with the world; overcoming the fear of being "crazy"; acquiring the will to recover, the feeling of self-control in the face of difficulties; helping to place "small brick over small brick", reciprocity in giving and receiving support; return to life through work; recovery as a balance "built on top of folly"; and last but not least, acceptance visa-vis of stigma -i.e., the difficult path from painful and harmful adverse reactions to stigmatization and hostility of others to the development of adequate strategies to cope with such obstacles.
Finally, the chapter "Indications for a MHS oriented towards recovery" is devoted to the role of services in steering the transition from the initial fear and panic reaction of most severely ill patients upon their first contact with a MHS to the gradual re-establishment of a network of social relations, both inside and outside the service, with special attention to the places and the contents of interventions. This work has been going on for a long time in collaboration between the Trieste MHS staff and other teams working in Stockholm (Alain Topor), Oslo (Marit Borg), and New Haven, CT-USA (Larry Davidson); and in addition to several contributions to the national and international literature (e.g., several articles in American Journal of Psychiatric Rehabilitation, 2005 and 2006), it has recently produced an important document, presented as work in progress, as a draft open to discussion: "For a Chart of Services Oriented Toward Recovery" (available in Italian: www.news-forumsalutementale.it/public/carta-dei-servizi-2012-web.pdf).
The last few pages are "Instructions for a coming out" by the second author, written "when I found the force and the courage to make my experience public. A real and proper coming out which has obliged me to tear up the veil of my decency". To conclude, it would be difficult to imagine a more effective description of how personal and social dimensions of mental suffering are inextricably woven together.
Edited by: Federica Napolitani Cheyne
a Life is a thrill that flies away, entirely a balance built on top of folly, maybe life wasn't all lost, maybe something has been saved!!
b The wind is rising! ... We must try to live! The huge air opens and shuts my book.
Harper's illustrated biochemistry: 29th edition lange basic science
Elena Bravo; Mariarosaria Napolitano; Ugo Visconti
Istituto Superiore di Sanità, Rome, Italy. firstname.lastname@example.org
Robert K. Murray, David
A. Bender, Kathleen M.
Botham, Peter J. Kennelly,
Victor W. Rodwell,
P. Anthony Weil
2012. 818 p.
$ 62.95 ( 49,36).
Harold Harper was born in San Francisco in 1911. He pursued his education in Biochemistry and completed a Ph.D. at the University of Southern California. Dr Harper was a tireless teacher and is remembered for his energy and enthusiasm as an advocate for basic science instruction. In 1939 he wrote the first of many editions of the textbook Harper's Physiological Chemistry, later Harper's Biochemistry and now Harper's Illustrated Biochemistry. Dr. Harper remained the sole writer until the ninth edition. A continuous chain of contributors was established by the authors: Peter Mayes and Victor Rodwell have collaborated since the 10th edition, Daryl Granner since the 20th edition, and Rob Murray since the 21st edition. Kathleen M. Botham began co-authoring with Mayes in the 26th edition and after his retirement, took over as a main author from the 28th edition. Because of the increasing complexity of biochemical knowledge, several contributors have been added in recent editions.
After its first publication in 1939, Harper's review was revised in 1944, and it quickly gained a wide readership, becoming a popular volume that has undergone periodic rejuvenations at intervals of approximately two-three years.
The current edition retains the original organization into about 60 chapters, and also keeps some classic features of previous Harper's editions, such as a clear index, the six main sections beginning with Biochemistry and Biogenetics and ending with special topics. Each chapter has been updated with advanced understanding and new technology and has been enriched with relevant clinical case reports. In addition to aging, new chapters dedicated to cancer and Clinical Chemistry have been included, with the latest consolidated acquisitions in these disciplines.
Several features make this relatively inexpensive volume a "winner-book" to recommend both as a review of Biochemistry lectures for medical students all over the world and as a handy reference for scientists who either have forgotten their Biochemistry or need an update. The attention given to the glossary, the increased number of figures and tables providing important information and definitions or showing useful data (e.g. the recommended nutrient intakes for vitamins and minerals) allow a quick and easy access to the terminology essential for the basic comprehension of the topic.
Each chapter begins with a clear set of the objectives that would be reached after studying the themes and with a brief introduction of the biomedical importance of the topics. Interestingly, the objectives are formulated to stimulate discussion that comes from the knowledge of the topic. A comprehensive index and the more than 250 multiple-choice questions give the student all the highlights, notes, and optional access to the practice-tests for their studies.
Winner features of success among students and readers are also its user-friendly pagination, its reduced size and its concise, clear and excellent English language.
La facilitazione in sanità: metodi e pratiche per migliorare il lavoro degli operatori sanitari
Istituto Superiore di Sanità, Rome, Italy. email@example.com
Pino De Sario (Ed).
Roma: Il Pensiero
2012. 241 p.
Methods and practices for
improving health workers
As affirmed by WHO (World Health Organization), health systems consist of all the organizations, people and actions whose primary purpose is to promote, restore or maintain health. They contribute extremely to better health and influence the lives and well-being of men, women and children .
However, even if health systems are responsible for the improvement of public health and life expectancy, vast gaps remain between their potential and their actual performance. A health system is a huge organization, characterized by differentiation and specialization of skills and activities, and by enormous costs associated with healthcare. This book is not meant to remove the complexity related to this great organization but is intended to serve as a guide for health personnel, as a tool to perform better in the healthcare multifaceted environment.
Improving the quality of healthcare and performing effectively to gain patients outcomes are challenging goals. But how can health professionals perform better, preserve health, respond to patients' expectations and also develop the ability to handle heavy workloads and act effectively under stressful conditions? The success of any effort to improve healthcare quality depends on the support and cooperation of colleagues at all levels of the organization, but we know that collaboration O between health directors, physicians, healthcare assistants can be tense and a typical work environment in a hospital can be extremely hectic and dramatic at times. This book responds to the dilemma by illustrating the method known as "expert facilitation".
The role of an expert facilitator is to help and support others to achieve high performance and to change their attitude, and also to improve cooperation, to motivate and promote empowerment. A facilitator helps other's thinking, planning and decision-making and supports the team in learning how to deal with conflicts. The goal is to turn negative emotions into something constructive, and to promote an atmosphere of collegiality to make a health department a pleasant place to work.
Expert facilitation is a team work style well suited to the variegated, multi professional and multi disciplinary hospital work setting. The authors suggest the adoption of the method in the health landscape so that physicians, nurses and health personnel in general can develop into facilitators. As this method helps health personnel to become more emphatic and to acquire communication skills, this can have a significant impact on the quality of services provided to patients. At the same time improving health and encouraging better performance at work could generate savings and reduction of healthcare waste. Therefore facilitation can turn out to be a key skill for anyone with responsibility for health quality improvement, but also for units structural reorganization, or in the need of process improvement and procedure upgrading, or of budget saving. This book is a guide designed to give the know-how and confidence to effectively use expert facilitation. In detail, the volume is composed of three parts: the first is on methodology, and it explains what is meant by expert facilitation: its principles and background, the sciences behind facilitation (psychology, biology, pedagogy but also management and sociology) and its accomplishment in the multifaceted, hectic healthcare environment. The second part of the book is about tools and techniques. Here we learn about the scheme called "face-model" which is made up of 4 areas of expertise that an expert facilitator should be able to put in practice: coordination, which implies good leadership skills and the ability to organize work with attention to the tasks of others; engagement, which means having effective communication skills to resolve differences, build trust and respect, improve relationships, teamwork, decision-making and problem solving; helping, mediating negative emotions and turning them into something constructive; and finally motivation, building a better workplace through specific techniques such as active meeting, debriefing or group (« learning. The last part of the book brings the readers real experiences reported directly by health professionals who utilized expert facilitation in their workplace. Here we find how the method has been used in different contexts (e.g.; a health director's office, a children's hospital, an oncology department, etc.) to highlight the method's strengths and weaknesses, and the drawbacks and benefits of its implementation.
1. World Health Organization. The world health report. Geneva: WHO; 2000.
L'atomo diviso: storia, scienza e politica dell'energia nucleare Giancarlo Sturloni
già Istituto Superiore di Sanità, Rome Italy. firstname.lastname@example.org
Milano: Sironi editore;
[The splitted atom:
history, science and
politics of nuclear energy]
The worries about existing and potential problems with our oil, gas and coal supplies for our industrial based way of living have certainly increased during the last few years. However, people enthusiastic about large scale technology, especially with some background in physics, are pointing quickly either to nuclear energy or to large scale solar power projects as possible solutions to such worries. Such views are supported by most economists and politicians who propose that one only needs to invest large amount of money to manage potentially existing problems with our fossil fuel based energy civilization. Such views about the future use of energy are often lacking the relevant facts about today's energy use and existing technological constraints. Instead, the preferred form of discussions seems to be dominated by theoretical and hypothetical ideas about unproven concepts with unknown capital costs.
From these considerations the question raised: Does nuclear power have a place in a sustainable energy future? This debate is about the controversy which has surrounded the deployment and use of nuclear fission reactors to generate electricity from nuclear fuel for civilian purposes. Proponents of nuclear energy argue that nuclear power is a sustainable energy source which reduces carbon emissions and can increase energy security if its use supplants a dependence on imported fuels.
Proponents advance the notion that nuclear power produces virtually no air pollution, in contrast to the chief viable alternative of fossil fuel. Proponents also believe that nuclear power is the only viable course to achieve energy independence for most countries. They emphasize that the risks of storing waste are small and can be further reduced by using the latest technology in newer reactors, and the operational safety is excellent when compared to the other major kinds of power plants. Opponents say that nuclear power poses numerous threats to people and the environment and point to studies in the literature that question if it will ever be a sustainable energy source. These threats include health risks and environmental damage from uranium mining, processing and transport, the risk of nuclear weapons proliferation or sabotage, and the unsolved problem of radioactive nuclear waste. They also contend that reactors themselves are enormously complex machines where many things can and do go wrong, and there have been many serious nuclear accidents. Critics do not believe that these risks can be reduced through new technology. They argue that when all the energy-intensive stages of the nuclear fuel chain are considered, from uranium mining to nuclear decommissioning, nuclear power is not a low-carbon electricity source. As a result of this debate the nuclear issue often excites strong emotions and there are widely differing views as to whether nuclear power can or should make a major contribution to reducing problems of an economically troubled and energy-starved population. Advocates for and against nuclear energy are equally passionate about their causes, and the understanding of the pros and cons of this energy source can surely help people to make a more informed decision about their own energy use.
In this book, the Author presents a personal memoir of the effort to harness energy from the atoms (Chapter 1) as well as telling the story of worldwide development of nuclear power, from its military use in the 1940s (Chapter 2) to its peaceful use of generating electricity in the world's operating nuclear power plants (Chapter 3), with a clear description of the tragic disasters of either Chernobyl and Fukushima (Chapter 4) that have once again ignited the debate on our dependence on nuclear energy, and of relevant safety issues and public perception of the risk (Chapter 5). As a physicist turned journalist and writer, the Author clearly reviews more than a century of worldwide scientific research, political moves, countermoves, and technological developments. Taking a pragmatic look at the nuclear world of today, he describes how the mistakes of the past set the tone for today's nuclear problems. He tries to steer a path through these controversies by relaying the views of those who are keen to promote nuclear expansion, looking at the challenges that face them, and at the arguments of those who support alternative approaches. Although there are discussions of how decisions making should be structured to avoid unnecessary conflicts, the aim is not to reach a consensus, but rather to present from a critical perspective a review of the debate, the idea being that knowing the pros and cons in detail will help know more about the debate and the issues involved.
This book also reflects the conviction that it is very important to shed light on complex socio-technical issues that will have a major impact on economy and society. The Author needed to formulate its words to make sure that explanations were simple, brief and intelligible to an intelligent audience. Although a few big words have inevitably crept in, he has kept the majority of arguments simple and straightforward, in order to answer to exactly the kinds of questions which curious laymen who know little about nuclear power may ask. The analysis and arguments treated in the book will surely stimulate constructive dialogue about the way forward, although the debate about the future role of nuclear energy will continue for many more years until the fog from the remaining unknowns becomes thin enough to distinguish wishful thinking from reality. Despite its relative small contribution to the world overall energy consumption it might thus be interesting to follow the evolution of nuclear energy closely and especially to compare past predictions (hypothesis) with the now known subsequent realities (experiment). Perhaps this method can lead to improved judgments about nuclear energy and its future development.