NARRATIVE MEDICINE, A TURNING POINT TO TAKE CARE OF DEPRESSION

22th January 2021 -Press Conference

Cover page of “Medicina Narrativa, un punto di svolta per prendersi cura della depressione”

The restrictions imposed by the pandemic due to the COVID-19 health emergency in order to slow down the spread of the contagion as much as possible have led to significant consequences not only from a health, political, economic, social and welfare point of view, but also from a psychological one. Deteriorating mental health, a higher prevalence of reported thoughts and behaviours of self-harm among persons with COVID-19 accessing mental health services, and evidence suggesting that previous epidemics such as SARS (2003) were associated with increased deaths by suicide, prompt a great deal of attention to the sensitive topic of depression.

Friday, January 22, between 11:00 and 12:30, a streaming press conference was held, dedicated to the presentation of the book entitled “Narrative Medicine, a turning point for taking care of depression -Narrative as an additional resource for dealing with past and present events during the pandemic”, published by Effedi. The manual about the use of Narrative Medicine, written by Maria Giulia Marini, Claudio Mencacci, Matteo Balestrieri, Salvatore Varia, Ubaldo Sagripanti, Maurizio Pompili, Paola Chesi and Luigi Reale, is configured as an additional resource in the care of people with depression, addressed to all health care professionals central to the prevention and treatment of a disease recognized by the World Health Organization (WHO) as the leading cause of disability worldwide, now further increasing as a result of the pandemic. 

The book is the result of the Out of the Blue Project, which wanted to carry out a 360-degree listening activity of people living with major depression and family members and health professionals who care for them, through a systematic collection of narratives according to these three points of view. Through writing, in fact, it was possible to capture additional aspects of daily life with major depression, and the elements that influence the re-emergence of this condition. The project is sponsored by the Italian Society of Neuropsychopharmacology (SINPF), the Italian Society of Psychiatry and the ONDA Foundation, and receives unconditional support from Lundbeck Italia.

The SINPF President and Director of the Department of Neuroscience and Mental Health of ASST Fatebenefratelli – Sacco, Milan, Dr. Mencacci, stressed the value of words, which heal together with the care of medical science and are located in the space of the meeting, in which there are dicibile and inexpressible, visible and invisible. The viral pandemic has been followed by other pandemics, including the one related to mental health, but also social and environmental inequalities, poverty and stigma have exploded, all factors that increase the risk of developing depressive disorders, as confirmed by the data of several international studies.

As Prof. Pompili, Professor of Psychiatry at La Sapienza University, President of the Italian Society of Suicidology, Department of Neuroscience, Mental Health and Sense Organs – NESMOS, Rome, points out, although we cannot yet make precise estimates of the impact of COVID-19 on suicide rates, we need to clarify that where mental pain is sown, the importance of recognizing the warning signs emerges. Indeed, it is in people’s narratives that there are the real reasons why someone decides to end it all. 

Empathy, listening, attunement and multidisciplinarity emerge among the main resources, together with Narrative Medicine, to be able to give voice to the remnants of suffering after the pandemic, in order to take charge not only of psychiatric diagnoses, but also of work and relational problems of a social fabric that has disintegrated. In this regard, Dr. Merzagora, President of the Onda Foundation, National Observatory on Women’s Health and Gender, also highlighted how the risk of job loss has significantly increased, especially for women, whose pay is increasingly low and whose employment rate has significantly decreased, reaching 17.9 percentage points of distance from the male one. Added to this is the increased burden of domestic and child management, as well as cases of domestic violence.

In this complex framework, we must not forget the caregivers, called to increase the time of cohabitation and to ensure presence and security care, physical and emotional, as recalled by the Vice President of the Italian Society of Psychiatry, Department of Mental Health ASP Palermo, Prof. Varia. Narrative Medicine is a patient-centered approach to care: by listening to or reading the stories of the disease, it is possible to grasp peculiar aspects of the person that are valuable for the elaboration of the personalized care plan. This project of care must also be updated with the needs of the use of new technologies dictated by the pandemic and presents us with new challenges. One of the most relevant is to be able to preserve empathy even remotely, as the Head of the Health Care Area – ISTUD Foundation, Dr. Reale, mentions “The rules to foster empathy” by John Launer.

In this regard, Dr. Sagripanti, ASUR Marche DSM AV3 – Civitanova Marche, borrowing the reference to the universe of participants from physics, affirms that “We have always participated, but now with Narrative Medicine we can bring back to scientificity that component that has been marginalized: we are human beings in front of other human beings. This is a huge revolution.” Prof. Balestrieri, Professor and Director of the Psychiatric Clinic of the University Health Agency of Udine, therefore, outlines how there is a need for someone who goes to welcome and take back the person, get him out of the closure and then a new attitude. That’s why this book is made to be consulted and experienced, as Dr. Chesi, Researcher and Professor of the Health Care Area – ISTUD Foundation, reminds us. It is an act to develop relational skills, which help to improve care relationships. In this regard, we recall the availability of the book also as a FAD course for health professionals (19 CME credits).

Narrative Medicine is gaining legitimacy as a tool to improve care pathways and relationships, and is increasingly being taught and applied in many care settings around the world. The World Health Organization (WHO) issued in 2016 a document for the application of narrative methods to be implemented in the different national health systems, and Italy in 2014 created the “Guidelines for the use of Narrative Medicine in clinical and care settings”, elaborated and presented by the Istituto Superiore di Sanità and addressed in a multidisciplinary way to professionals working in the social-health field.

Dr. Marini, Scientific and Innovation Director of the Health and Healthcare Area – ISTUD Foundation, reminds us that Narrative Medicine is democratic. It is able to unite patients and health professionals, to associate evidence-based medicine and narrative-based medicine, as well as clinical sciences and human sciences. It allows us to expand our gaze, considering that man is part of a greater cosmic movement.

You can find the videorecording of the press conference at this link:

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