In Memoriam Marco Scarpinati Rosso, MD (June 2010)

Marco Scarpinati Rosso

The bio-sketch below was prepared for publication in the Nov, 2009 issue of the WPA-TPS Newletter. The text has been edited for the purpose of this tribute to the memory of Marco Scarpinati Rosso, who died Sep 1, 2011, after a brief illness and surgery.

An In Memoriam Tribute to Marco Scarpinati Rosso, M.D.

When Ron asked me to contribute some short biographical notes to this website my first inclination was to decline. As a pretext, I could use the lack of time because of my clinical duties and my research project but, basically, the fact is that I do not like to talk about myself.

However, driven by curiosity, I decided to take a look at the TPS Newsletter and to read some stories written by colleagues and friends. I was really impressed by the generosity and sincerity they introduced in their own narrations dealing with very personal issues. Moreover, I felt that I share feelings and experiences with a lot of them. So, overcoming my shyness, I decided to write something, even if short.

I was born and raised in Rome. My father, a gynecologist, came from a family of doctors and my mother, of French background, from a family with a long heritage of military officers. Her father was in the diplomatic service, so they travelled a lot. I am still convinced that the fact that she could speak French and Arabic played a big role in my current professional interests. I attended the Classic Lyceum – secondary school with a lot of Latin, ancient Greek and philosophy courses – and then medical school at the La Sapienza University in Rome.

I must confess that I did almost anything to avoid becoming a psychiatrist, even though I was really attracted by this discipline from the begin¬ning of medical school. I thought it was very difficult clinical work, with poor treatment outcomes and a high degree of stigma associated with the field. So, to make my life easier, I specialized in neurosurgery; and then I joined the army, becoming a professional medical officer. In this way I was able to make an effective synthesis of my family’s traditions in both medi¬cine and military service.

But as so often happens, it is not you who chooses psychiatry, but rather it is psychiatry that chooses you, and nothing can prevent it when you receive the call. In my case, I became a psychiatrist – and at the same time, a cultural psychiatrist – because of a very concrete cause: war.

Although my primary post was the military hospital in Rome, I have been deployed sev¬eral times abroad, in different conflict areas in peace-keeping and peace-enforcement operations. During these missions, trauma was a constant aspect of my daily clinical work with the military personnel and with the civilian population that we protected and cared for. Dur¬ing the Kosovo crisis, I was deployed as an observer for the OSCE (Organization for Security and Cooperation in Europe) in the capital, Pristina. Before the NATO bombing of Serbia, our unit moved to Macedonia to organize and monitor the refugee camps near the borders. During this mission I confronted the complex and grave burden of the direct efects of war on the population, and the impact that violent ethnic discrimination, displacement and loss have on peoples’ mental health.

This experience has influenced me in several ways. From the clinical point of view, I felt a need to approach the complex phenomenon of trauma from a different and more global perspective, scrutinizing the tight paradigm of PTSD as we use it today. From a broader perspective, I understood that the current models of intervention in relief activities are not effective. Moreover, I thought about the major challenge societies and health services face as a consequence of globalization and the need for a cultural perspective in psychiatry.

Thus, I decided to become a cultural psychiatrist and to increase my knowledge and skills through research. Accordingly, I undertook my specialty training in psychiatry in Rome – thereby changing my clinical perspective from neurotraumatology to psychotraumatology. I resigned from the army and I decided to move to whereever I could realize my clinical and research objectives as a cultural psychiatrist.

My research interests are in cross-cultural psy¬chopathology, psychotraumatology and the interactions between the cultural mind-sets of patients on one hand, and the health services system on the other.

After all these years of clinical practice, I must admit that I still do not believe that cultural psychiatry is radically different from general psychiatry. The needs of the patients are almost the same; to be understood and respected.

But what is really important and unique is that cross-cultural psychiatry can contribute to the reflections on psychiatry itself, about its asymmetrical power relationships between patients and their families, and the health services personnel who provide treatment for them; as well as how to avoid the stereotyping of people as patients. These perspectives are greatly needed in all aspects of contemporary psychiatric practice

In Memoriam tribute to Marco Scarpinati Rosso

Henrik Wahlberg and Antti Pakaslahti

Marco was exceptional. We are all special, but Marco was exceptional.

Marco was gifted, refined and deeply humane. His family combined generations of doctors, commissioned officers and diplomats. He completed a classical education with emphasis on Latin, Greek and philosophy. He graduated in medicine from La Sapienza University in Rome and then completed post-graduate training in neurosurgery. After specialization in neurosurgery he became a medical officer in the Italian army He participated several times in peacekeeping missions and also served a tour of duty in the Antarctic.

Marco was confronted with ethnic persecution, displacement and atrocities and their complex and grave burden on people and their mental health, particularly when he participated in the OSCE peace- monitoring mission during the Balkan wars in the mid-1990s. Efforts to ameliorate the traumatic impacts of inter-ethnic conflicts in the Balkan region taught him new aspects of posttraumatic treatment.

Marco’s experiences revealed the importance of psychology and psychiatry, and of mental health in general. Marco said about his specialization in psychiatry: “it is not you who choos¬es psychiatry, but rather it is psychiatry that chooses you, and nothing can prevent it when you receive the call”.

He worked as a chief physician in Uppsala, Sweden, from 2003-06 and learned to speak Swedish within a few years. He worked from 2007-09 in Stockholm, where he was simultaneously a PhD candidate at the Karolinska Institute. During this year he was nearing completion of his thesis in transcultural psychiatry.

Marco was appointed as head of the Department of Emergency and Consultation Psychiatry at the Akademiska Hospital in Uppsala and returned to live there in 2010. He was full of energy and enthusiasm. He was determined to develop and improve the quality and cultural sensitivity of psychiatric care in that department.

In his professional work Marco stressed:
1. The need for patients to be understood and respected as persons.
2. The importance of avoiding the stereotyping of people as patients.
He tried to implement these principles in the daily clinical activities of the emergency unit, and he combined them with high quality and efficiency of clinical care.

He impressed us all with his astounding capacities for humane and sound clinical intuition. Marco’s humane nature guided him in everything he did. He worked closely with the recipients of treatment and with their families. He managed to give hope and dignity to those people. He included a representative of the recipients of care in the managing board of his department.

Marco was an enthusiastic member of CPPN, the Nordic Network of Cultural Psychology and Psychiatry. He contributed to the network and actively participated in CPPN meetings in the Nordic countries. He was also an active member of the WPA-Transcultural Psychiatry Section and participated in many WPA-TPS conferences, usually accompanied by his wife, Piera.

He had friends all around the world.

Marco liked Uppsala very much. Uppsala is a small university city, where Carl von Linnaeus made his discoveries. After working in different countries and travelling widely throughout his professional career, Uppsala became his home.

Marco’s legacy at the psychiatric hospital in Uppsala, and to psychiatry in general, is to treat patients as friends and treat them
with professionalism and kindness!

Marco’s unexpected passing came as a shock to his friends in Sweden and around the world. His generous spirit lives on in our hearts and in our memories.

Henrik Wahlberg
WPA Board member
Coordinator of CPPN, Sweden

Antti Pakaslahti
Adjunct Professor of Transcultural Psychiatry
School of Health Sciences, University of Tampere, Finland

Memoriam tribute to Marco Scarpinati Rosso

Solvig Ekblad, PhD

I met Marco for the first time several years ago, when he worked with refugee children as a clinical psychiatrist. My first memory was Marco’s distinctive professional clinical eye and a wish to know more about cultural formulation in Sweden. During his work as a consultant psychiatrist at the Transcultural Centre, Stockholm, he invited me several times to lecture in courses for clinical staff encountering patients with refugee backgrounds. His research interests in cross-cultural psychopathology, psycho-traumatology and the interactions between the cultural mind-sets of patients on one hand and the health services system on the other, resulted in Marco becoming a PhD student at the Karolinska Institutet, Stockholm. Last year he passed his half-way control seminar and was nearing the end of his PhD studies. His thesis of great potential importance will now not be finalised, but I do hope that his supervisors will publish his data as a tribute to his memory.

I also encountered Marco in two international contexts; in the Nordic network in transcultural psychiatry and psychology, and when he participated in the post-graduate course on Global Mental Health: Trauma and Recovery, comprising both on-site learning and web-based learning 2009/2010.

In his motivation to participate in the Global Mental Health course Marco wrote the following: “I applied to this course for two main reasons. From the clinical point of view, I felt a need to approach the complex phenomenon of trauma from a different and more global perspective, scrutinizing the narrow paradigm of PTSD as we use it today. Further, due to my previous experience in the field, I strongly believe that the current models of intervention in mental health relief activities are not effective. I am looking forward to meeting the faculty and colleagues in order to share knowledge narrations, experiences and – why not, -dreams” (p. 7).

During the last course 2010/201,1 was invited to be a resource person in the international team of facilitators, which I have been in since the inception of this course five years ago.

Marco shared with me some of his knowledge narrations when we met at dinners with other colleagues in central Stockholm or in Italy. The same week when Marco passed away I tried to contact him to arrange a time for a dinner after the summer holidays.
Unfortunately, it was too late. What we did not know was how serious his health problems were. He had a strong integrity, something that deserves our respect.

He passed away too young, but his knowledge narrations in transcultural psychiatry must continue; not only in Uppsala, Stockholm, and the rest of Sweden, but also in the Nordic countries and other countries around the world.

All of us who knew him and liked him have a responsibility to help Marco’s dreams become reality.

I send my condolences to his family in Rome.

Solvig Ekblad, PhD
Senior researcher and Associate professor in transcultural psychology at Karolinska Institutet, Stockholm, Sweden
Member of the Nordic network in Transcultural psychiatry and psychology

In Memoriam tribute to Marco Scarpinati Rosso

Richard F. Mollica MD MAR

I had the good fortune to meet Marco as a trainee in my Global Mental Health Course in Italy just over 2 years ago. He was in my small group weekly discussions, along with other international medical providers for over five months. Almost immediately I noticed his wonderful intelligence and wit. He had that Italian skepticism of all sacred cows that I loved. Because of his brilliance and insight, I invited him to help start our Global Mental Health Alumni Association.. He dived right in and has done a great job.

On two occassions I met him in Sweden at the Karolinska Institutet ( KI ) where he was studying with my close colleague Professor Solvig Ekblad. At KI he was greatly respected and had a promising academic future.

All of us at the Harvard Program in Refugee Trauma ( HPRT ) and the international faculty of the Global Mental Health Program are shocked and saddened to hear of his death. He was clearly a brilliant and passionate doctor and human being who cared deeply about his patients and his friends.

Marco confided in me about his long journey from being a neurosurgeon in the Italian Army, working in conflict zones, to his cultural psychiatry thesis at KI, to his main clinical preoccupations as a clinical director of a large psychiatry program in Sweden.

He was a man of extraordinary courage on insight.
It is heartbreaking for all of us to hear of his death at such a young age.

In fond remembrance;

Richard F. Mollica MD MAR
Professor of Psychiatry
Harvard Medical School
Harvard Program in Refugee Trauma
Massachusetts General Hospital

In Memoriam Tribute to Marco Scarpinati Rosso

Wolfgang Rutz

Marco Scarpinati Rosso, an Italian – Swedish psychiatrist, a dear colleague and beloved friend of many of us, has left us suddenly and unexpectedly in a time full of activities, future plans and shared projects.
At the time for his death, he was one of the leading chief psychiatrists at the academic university hospital in Uppsala, heading the emergency unit as well as the center for psychiatric stress research.

Marco was Italian, a Roman citizen, humanistically educated, with a strong foundation in ancient philosophy and languages, and consistently striving to give this humanism a modern , relevant meaning in Sweden, his other homeland, in modern Swedish psychiatry. He felt close to humanistic sciences – striving to integrate positivistic knowledge of neuro-psychiatry and neurology, with,psychosocial dimensions of human ecology and mental environment, into the human condition of being body and mind, acknowledging psychiatry’s closeness to and overlap with anthropology, cultural sciences, philosophy and literature.

Marco was educated in Italy, he studied in Rome, completed a PhD there and became specialized in both psychiatry and neurosurgery. At the time of his death he was working on his second PhD dissertation at the Karolinska Institute in Stockholm.
His focus was international and transcultural. He had worked in several countries, including the Balkan countries, helping people in the posttraumatic throes of internal warfare and conflicts, with a strong dedication to individuals and on a societal level, and with a focus on crisis reactions and posttraumatic stress.

When I met him after coming back to Uppsala following seven years in the World Health Organization, we joined in a common network of friends and psychiatrists, elaborating on psychiatry’s psychosocial, biological and even existential dimensions, working both with treatment and pathology but even with salutogenesis and health promotion – fully aware of an holistic “Conditio humana”, in need of being applied in integrative, psychiatric and psychosocial person-oriented clinical work.

Marco later left Uppsala, to work in transcultural psychiatry in Stockholm. One of his main focuses was on refugees and their apathetic children who had become a major political issue at that time in the Swedish political and even professional discussion. Here he focused on clinical work and publications on the psychosocial and existential causalities behind these conditions and even argued intelligently and sharply in discussions and symposia about the fate of “paperless” (undocumented) refugees in Sweden, who at that time had no reasonable access to most basic human rights, such as education and medical treatment. That the situation since then has changed somewhat for the better is due in some part to Marco’s efforts and commitment.

When he came back to Uppsala about a year ago (unfortunately, after my retirement), he soon became again a central figure in a group of dedicated psychiatrists, working toward the goal of re-humanizing psychiatry, including human beings’ humane aspects and – above necessary guidelines and protocols – treating and supporting patients in a personalized, individual and narrative approach, meeting them at the level of equals, inter-subjectivistic and empathic, as persons, not merely diagnoses and syndromes.

To exemplify this, his last project was to present Uppsala’s psychiatry in the context of the city’s “Cultural night”, connecting psychiatric clients to persons from world literature, thus showing the commonality and generalizability, as well as the philosophical and existential interconnection of mental and psychiatric suffering.

Marco was a humanistic, ethically sensitive, gifted and hardworking professional, striving from an holistic point of view to put psychiatry in perspective and give it an outstanding place among the most complex medical specialties, within the context of an academic hospital environment. However, he was clearly aware that psychiatry – like other medical disciplines – had to be seen and treated in the psychosocial and existential context of human life, and that here, psychiatry hopefully was in the forefront of the development of other medical disciplines and specialties.

As a colleague and friend, Marco was consistent, demanding and generous, warmhearted and spiritually stimulating, knowledgeable and innovative, not fearing to be authentic and even controversial when fighting for the ideas he considered important – and he was loved, respected and sometimes greatly admired by his patients.

He was a fighter in the struggle to re-humanize psychiatry, to counteract tendencies to reduce psychiatry to merely a neuropsychiatric medical specialty and efforts to instrumentalize both the psychiatric profession and its clients in a more and more market- and profit-oriented health care system.

He was to us a model of a psychiatric professionalism that has profound humanism and philanthropy at its foundation, as a “conditio sine qua non” and as a final goal.
We will miss him. It will be difficult to fill the role that he has left open in the development of a modern people-oriented Swedish and international psychiatry.

Stockholm / Coburg, September 2011
Wolfgang Rutz, MD, PhD
Professor of Social Psychiatry
f. WHO Regional Advisor for Mental Health in Europe, 1998 – 2005
f. Vice President, Swedish Psychiatric Association

In Memoriam Tribute to Marco Scarpinati Rosso

Marianne Kastrup

I had the pleasure to meet Marco Rosso when he was working at the Transkulturellt Centrum in Stockholm. He was the core person behind the Swedish adaptation of the DSM-IV Cultural Formulation and we at the Danish Centre of Transcultural Psychiatry in Copenhagen were fortunate in that Marco agreed to come to Copenhagen and lecture about his research and clinical experiences with the Cultural Formulation. This led to the development of a Danish adaptation – inspired greatly by the Swedish version –and we are grateful to Marco for his constructive feedback.

But Marco’s unique style also made this symposium particularly memorable. Sitting there in a cold, not very charming auditorium, the entire audience was charmed by his Italian sense of humor when he was talking about his encounter with Scandinavian psychiatry assessing patients to be depressive – when in fact they were “just Swedish”.

Later, I was fortunate enough to participate in a transcultural congress in Norcia with Marco and his wife, and I still remember how that scientific program was spiced with wonderful encounters with Italian cuisine and further developing our friendship

This is how I recall Marco. He was able to combine scientific rigor with a humanistic approach, and able to flavor it with a particular charm.

He shall be greatly missed.

Marianne Kastrup
Centre for Transcultural Psychiatry, Denmark

In Memoriam tribute to Marco Scarpinati Rosso

Ronald Wintrob MD
Chair, WPA-Transcultural psychiatry Section (2009 – 2011)

In 2009, I had invited Marco to contribute his bio-sketch and photo for a series of bio-sketches of people who had become members of WPA-TPS during 2008 and 2009. He prepared a very impressive and highly personal article about the growth of his interest and commitment to cultural psychiatry. His article, and accompanying photo, were published in the Nov, 2009, issue of our TPS Newsletter.

After receiving the very sad news about Marco’s untimely passing, at much too young an age, and in the full flower of his productivity as an innovative contributor to the field of cultural psychiatry, I re-read Marco’s wonderfully expressive bio-sketch.

We have done some minor editing of his bio-sketch, for the purpose of including it as the lead article in this in memoriam tribute to Marco’s memory, along with a photo of Marco taken in June, 2010, during the TPS-sponsored international conference on cultural psychiatry, held in Amsterdam.

During that conference, Marco wanted to talk with me about the plans he was working on for the development of cultural psychiatry research and teaching in Sweden and internationally. He was very enthusiastic, and I strongly encouraged him, since his ideas struck me as both sensible and useful.

I was particularly intrigued by his plan to prepare a series of articles on the life experiences and professional development of a number of cultural psychiatrists of Italian background, especially those who were the children of immigrants to USA, Canada, Australia and to a number of countries in Latin America and Europe, where these immigrant families established themselves and influenced their children to become physicians, psychiatrists and cultural psychiatrists.

Another aspect of this project that he spoke about in some detail was about the cultural adaptation and the contributions to cultural psychiatry research and teaching of people like himself, who had migrated to other countries and established very productive lives and careers there.

Marco was an excellent contributor to our field. He was an enthusiastic colleague. And he was a very likable man.

He will be greatly missed.

Providence, RI, USA
7 Sep 2011