Review of the book by Giuseppina Gabriele and Emanuele Caroppo (Scione Editore, 2025)

With Care as a Necessary Risk, Giuseppina Gabriele (psychologist, Director of the Mental Health Unit of District 6, DSM, ASL Roma 2) and Emanuele Caroppo (psychiatrist, Head of Planning and Research at the Mental Health Department of ASL Roma 2) sign a work that is, above all, a political gesture. Not an abstract manifesto, nor a technical handbook for insiders, but an act of restitution: an attempt to bring mental health back to its most radical meaning—the one embodied in the daily practice of a public service that resists—and R-esists—within one of the most fragile and complex areas of Rome.

The book opens with a statement that perfectly captures its spirit: “Memory is never a neutral act: it can be reduced to nostalgia, or transformed into consciousness.” This applies to Italian psychiatry, heir to the Basaglian revolution, but also to those who today work, live, or seek care within the services.

Gabriele and Caroppo do not celebrate: they question. They do not console: they provoke. They do not defend Law 180 as a monument, but reactivate its meaning, reminding us that every achievement can be dismantled, that “going backwards is always possible.”

The book’s most powerful value lies in its polyphony: nurses, psychiatrists, psychologists, rehabilitation technicians, educators, but also users and families. Across its chapters, more than thirty authors recount episodes, scenarios, ethical dilemmas, exposing daily work for what it is: fragile, artisanal, never taken for granted.

In his preface, Massimo Cozza calls the volume “a powerful training tool” and clarifies a crucial point: these pages do not explain how one should work—they show how work actually happens in community services, often with insufficient resources, “making do with very little” and yet producing real change through a network of relationships and therapeutic alliances built over time.

The heart of Basaglia’s reflection constantly returns: care is always a complex relationship, never the mere elimination of symptoms. The reduction of the human to a diagnostic checklist is openly criticized: “Psychic suffering can never be reduced to a single symptom.” Care, therefore, cannot be a technical gesture but an encounter. “Learn all the techniques, then, when you meet the patient, suspend judgment.” The book revives this Basaglian lesson with particular force, denouncing a widespread yet silent cultural risk—the risk of “defensive” practitioners, overwhelmed by an implicit mandate for social control rather than a vocation for care.

One of the book’s recurring threads is its denunciation of the creeping transformation of psychiatry into a tool for managing collective fears: the confusion between mental disorder and social dangerousness, the improper burden placed on community mental health centers after the closure of forensic hospitals, and the growing pressure toward security-based rather than therapeutic responses. The text is explicit: “Mental disorder ≠ social dangerousness”—an equation that, if not dismantled, risks producing new forms of segregation, “less visible but equally erosive of citizenship.” This is not rhetoric: it is structural analysis, laid bare by those who experience daily the real impact of political choices on people’s lives.

Perhaps the book’s most original contribution lies in its redefinition of the Community Mental Health Center: not a clinic, but a node. A place that only makes sense if embedded in a territorial network—schools, parishes, cooperatives, associations, active citizens. Care is never only clinical: it is always also social, cultural, political. This concept recurs in many voices throughout the volume, especially when describing daily practice: “Mental health is made in rooms, neighborhoods, homes.” This is not a romantic image: it is a fact. Mental health lives in reality, not in protocols. The book vividly shows how a neighborhood can become a therapeutic or pathogenic factor, and how practitioners must constantly read and transform the context, not just the patient.

The title is not metaphorical. The book insists on the concept of therapeutic risk: care requires exposure, not protection. Risk is not recklessness, but responsibility: risking empathy, risking closeness, risking not being shielded by a “position of guarantee,” risking failure alongside the patient, risking not having ready-made answers. It is a revolutionary stance, especially in a system that tends toward administrative efficiency, standardization, and the elimination of gray areas. The authors remind us that care happens precisely there—in the gray zones.