“Sulla terra in punta di piedi” or tiptoeing on the ground: a book by Sandro Spinsanti

Human Sciences books for Health run the risk of being theoretical-pedagogical manuals, with little reference to clinical practice; otherwise, they seem pindaric flights between art and literature, even here with little applicability to reality.  This happens in Italian as in international publications. In addition to that, it is always clear from the first pages whether the author “knows the health system” for having followed it in its being, in its immense problems, on the line between health and disease, between life and death, between the profession as a mission or as a set of technical acts. 

Sulla Terra in punta di piedi [which translates to Tiptoeing on the ground, Ed.] is a book written by Sandro Spinsanti that does not leave any fields of knowledge behind, and does not separate them into watertight compartments, but weaves them together, moving with ease from Ethics and Bioethics, to Spirituality (in its various historical and geographical meanings), to Literature, Painting, Music, Law, Science with its method of Evidence Based Medicine and other disciplines. The style is ironic and light, in dealing with topics of extreme delicacy, such as the instructions not to make a bad death, how to find the elegance in dying, how to remove the deception of the gift of suffering given by the disease (he calls it compensatory pain), indicating that perhaps behind these statements there is a personality with a marked trait of self-punishment, or the topic of the volunteers sometimes unprepared and so useless. In short, it is a piece of writing that wants to show the moon, putting aside the finger pointing at it. 

Spinsanti is looking for some kind of truth, which I will try to put into words having read the whole book: the first truth is that the parts and the fields of knowledge must be connected harmoniously, without too much moralism or identification, with elegance, standing on the ground on tiptoes. This especially is true nowadays since we are at a turning point, after paternalistic healthcare and after the dogmatic healthcare of EBM, moving in a more narrative direction. Proof to that is the fact that many Universities in the States, in Europe and in Italy too, open their medical pathway to complementary courses (even if, unfortunately, they are not yet mandatory). Future doctors and nurses will be less the children of “Sackett and the Probability Number” at all costs, whatever it may be, and more the children of the humanistic culture, united without exclusion with scientific competence.

The second truth is that Professor Sandro Spinsanti is an advocate for the freedom of the individual, promoting the spirit of self-determination, the liberty to choose whether to “believe” or “not believe” in something: this freedom is also that “of going around elegantly when ill” in a society which massifies us with a Stereotyped Health and Thought.  It is not a naïve freedom, but one that can only arise from awareness, and therefore from the truth of how things stand in regard to the state of health and illness. Again, this freedom is also to be found in the author’s style of writing: Spinsanti does not mind finishing a chapter without first having ranged between different authors, writers, philosophers, scientists, doctors, theologians, with sometimes opposing thoughts, leaving the reader with a plurality of visions and possibilities.

The third truth is that Spirituality can be found in the gestures of care, in the relationship with the other, the caregiver and the patient, in the intersubjectivity, in the respect for the patients’ decisions and in the work created by the artist within each of us. A Spirituality that can be grown through evolutionary psychology, together with the fascinating integral theories of consciousness, as well as through meditation techniques, including mindfulness, yoga, and listening to music and contemplation in front of a painting.

Which brings me to the fourth truth: the author’s tension to trace statements, words, and human questions back to the root of history, demystifying today’s terms, such as mindfulness, and tracing it back to six centuries before Christ, linking it to the genesis of Buddhism. Spinsanti beautifully explains how the two Latin gods Ianus and Terminus can enlighten which spirit we can cure with and which spirit experience a transition from Health to Disease with. The god Terminus was the protector of borders, and stones were placed as Terms of a territory: similarly, there may be seen a gap between Health and Disease.

On the other hand, the god Ianus is the protector of doors, of open thresholds, whether they are of this world or to other worlds (in the book Spinsanti also dwells on the experience of premortem death): as a consequence, there is no longer a boundary, no terminal stone between health and illness, between life and death, disappears. It is therefore up to us to choose with which spirit (without here exalting the gift of suffering) to face the loss of health in order to embrace illness.  And perhaps this is the way to save ourselves and not only to heal.

Quantum physics comes to our aid, unconsciously using the two divinities in the same way: Terminus is corpuscular matter, Ianus is continuous wave, without interruption.  The beauty of the Classics is that they were able to keep in mind a polarity, without losing coherence. It works the same way for the disease: depending on how we observe, sometimes there will be the material body, corpuscular, with the Term stones speaking, and at other times there will be the disembodied being, with wave movement that crosses the Gates, wherever they are to create. 

And the fifth truth is the importance of Silence, which generates welcome, tranquility and emptiness: in a world full up with too many words, very few of which are effective, and many of which are anemic and dangerous, as we are experiencing them withand onour skin in this first year of the Covid era, Silence is the masterpiece to recreate in order to prune and refocus ourselves in the midst of the continuous Whirlwind. It seems that Silence has a Latin etymology, partly related to the obvious “tacere”, but perhaps even more ancient, Sanskrit, that “SI” – repeated in all languages, the ssscccc, which is pronounced to children tired of crying, to make them fall asleep…

They whisper me, Sleep, they whisper me, Sleep!
there, light blue darkness voices … 
They seem lullabies to me,
that bring me back to how I was…

(Giovanni Pascoli, My Evening, in Canti di Castelvecchio)

The book Sulla terra in punta di piedi is beautiful.

Maria Giulia Marini

Epidemiologist and counselor in transactional analysis, thirty years of professional life in health care. I have a classic humanistic background, including the knowledge of Ancient Greek and Latin, which opened me to study languages and arts, becoming an Art Coach. I followed afterward scientific academic studies, in clinical pharmacology with an academic specialization in Epidemiology (University of Milan and Pavia). Past international experiences at the Harvard Medical School and in a pharma company at Mainz in Germany. Currently Director of Innovation in the Health Care Area of Fondazione ISTUD a center for educational and social and health care research. I'm serving as president of EUNAMES- European Narrative Medicine Society, on the board of Italian Society of Narrative Medicine, a tenured professor of Narrative Medicine at La Sapienza, Roma, and teaching narrative medicine in other universities and institutions at a national and international level. In 2016 I was a referee for the World Health Organization- Europen for “Narrative Method of Research in Public Health.” Writer of the books; “Narrative medicine: Bridging the gap between Evidence-Based care and Medical Humanities,” and "Languages of care in Narrative Medicine" edited with Springer, and since 2021 main editor for Springer of the new series "New Paradigms in Health Care."

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