Psychiatric Epidemiology

The modern methods of psychiatric epidemiology were developed and defined in the 1970s and 1980s. While psychiatric epidemiology describes how mental disorder is distributed a population, it can also help reveal causes and indicate possible treatments. As Lee Robbins, a pioneer in American psychiatric epidemiology has stated, “the epidemiologist tries to find out which portions of the population are at the greatest risk of becoming mentally ill, which recover quickly if they do become ill, and which are more likely to relapse after a temporary remission. By noting who is at high risk, the epidemiologist gets clues as to the possible causes of the occurrence of psychiatric disorder.” [Archives of General Psychiatry, June 1978.]

Modern psychiatric epidemiology advanced its goals by developing survey instruments that could accurately measure psychiatric disease in the general population for the first time. A shift from studies of psychiatric patients to studies of mental illness in local communities also occurred, creating a revolution in understanding the frequency of specific types of mental illness as well as identifying those risk factors and resiliency factors associated with psychiatric disorders.

Epidemiological studies of the mental health impact of natural disasters in Italy (Chierzi, Toniolo et al., 2014; Minerva Psichiatrica, 55:91-103) have revealed the major mental health disorders associated with modern catastrophes in the Italian setting. These studies along with considerable international research reveal that six to twelve months after the earthquake the percent of those suffering severe mental illness for adults is 25% and for children is 15%.

This data reveals that exactly at the time a disaster loses media attention, the mental health crisis among the survivors loom large and is quite severe. Based upon this scientific work, it is exactly at this time that INTC enters the local setting in order to provide culturally effective mental health care to all survivors. Unfortunately, social and political biases, ignorance and neglect still sideline effective mental health care for trauma survivors in Italy. Science is denied. But as the American sociologists of Kingsley Davis in 1936 shows, empirical scientific methods can unmask the treatment realities underlying the dogma and ideology that defends any treatment system. As Davis stated in his essay, Mental Hygiene and the Class Structure:

“Mental hygiene hides its adherence behind a scientific façade, but the ethical premises reveal themselves on every hand, partly through a blindness to scientifically relevant facts…In so far as the mental hygienist retains his ethical system, he misses a completed scientific analysis of his subject and hence fails to use the best technological means to his applied-science goal. But if he forswears his ethical beliefs, he is alienated from the movement and suffers the strictures of an outraged society. Actually, the mental hygienist will continue to ignore the dilemma. He will continue to be unconscious of his basic preconceptions at the same time that he keeps on professing objective knowledge. He will regard his lack of preventive success as an accident, a lag, and not as an intrinsic destiny. All because his social function is not that of a scientist but that of a practicing moralist in a scientific, mobile, world.”

Italian Psychiatric Reform

It cannot be under-estimated how the Italian psychiatric reform influenced the young team at the Harvard Program in Refugee Trauma (HPRT) in its clinical pioneering clinical work in refugee mental health in America and globally.

The Italian reform also offered the concept of the “Second Disease,” the disease caused by the social exclusion, neglect and mistreatment of patients. Indeed, these medical pioneers helped us not to forget that all natural disasters are political events – events that have a major positive and negative social, cultural, and health impact on survivors. And that the disaster relief policies of a country and a region can cause worse suffering on the survivors overtime (i.e. Second Disease) than the disaster itself.

The great humanistic philosophy of Franco Basaglia that focused on preserving and promoting the dignity of all mentally ill patients in non-stigmatizing, caring, restorative environments has been a central principle of the INTC. The Italian reformers denied the neutral, apolitical role assured by psychiatry at that time.

“And so we have, on the one hand, a science ideologically committed to the quest for the origins of an illness it acknowledges to be ‘incomprehensible’ and, on the other, a patient who, because of his presumed, ‘incomprehensibility,’ has been oppressed, mortified, and destroyed by an asylum system that, instead of serving him in its protective role of therapeutic institution, has, on the contrary, contributed to the gradual and often irreversible disintegration of his identity” (p.29).

Scientific and Cultural Treatment

INTC is also committed to offering in the field and at the local level culturally sensitive and scientifically based (evidence-based) clinical methods of diagnosis and treatment. These are called “Best-Practices.” The Harvard Italian Team has translated and adapted the Harvard Trauma Questionnaire (HTQ) and the Hopkins Symptom Checklist 25 (HSCL-25) into Italian to use for screenining for posttraumatic stress disorder and depression, respectively. The INTC, through its scientific coordinator, Sonia Graziano, has translated into Italian Harvard’s 11 Point Toolkit.

The 11 Point Toolkit is available for the training of Italian general practitioners and nurses, psychologists, and social workers, working I the natural disaster areas. It has also been made available to Italian first-responders in the Civil Protection, Italian

A Pantheon of Brilliant Hearts and Minds

The INTC has been three decades in the making and has finally come to fruition. An anonymous donor and the National Italian American Foundation (NIAF) has generously supported the INTC. The sociology-trained INTC President, Giampiero Rosati, has served as a dedicated administrator for the Harvard Team over the past twenty years. Similarly, Dr. Sonia Graziano has been a dedicated scientific coordinator of all of Harvard’s trauma relief efforts in Italy. The Harvard-Italian Team includes distinguished Italian and American medical experts and psychiatrists. The core Harvard Team includes Richard F. Mollica, James Lavelle, Maya Habboush, and Eugene Augusterfer. The core Italian Team includes Giampiero Rosati, Sonia Graziano, Giovanni Muscettola, Giampaolo Nicolais, and Irene Toniolo. The Team is also made up of a generation of medical and mental health professionals in training including Sergio Lucchi, Catarina Nicolais, Francesco Rosati, and Chris Mollica.