Abstract
After a synthetic characterization of mental disabilities and of the socio-economic determinants of their growing, the paper focuses on two major issues. On one hand, which policies can be envisioned to cope with the inhumane disability employment gap, especially as far as the neuro-divergent people are concerned. On the other hand, how to accelerate the transition from the by now obsolete model of welfare state to the community welfare model in order to implement practically the subsidiarity principle. A final section suggests that if the ultimate goal is to arrive at a substantial social inclusion of all disabled people it is necessary to introduce into the institutional design the agape principle.
1. Introduction
October 10, 2023 marked World Mental Health Day, established in 1992 by the World Health Organization, with the aim of increasing the perception of the urgency of combating the stigma still persisting on the issue. The term “mental health” is not limited to the mere absence of mental pathology or existential distress, but refers to the state of inner balance that enables a person to use all the emotional, cognitive, social and physical resources available to him or her. Today, medicine clarifies how there is no separation between body and mind. Therefore, mental health does not end with psychological well-being alone, but involves a more global dimension of the person.
Mental suffering has always been accompanied by fear and shame, and while it is true that today mental pathology is viewed differently than in the past, partly because there are effective therapies for it, it is equally true that social prejudice and the stigma of incurability are still so deeply rooted. People with mental disorders are often viewed as dangerous by society, and mistrust of doctors who deal with these conditions is one of the biggest barriers to accessing treatment. Talking about mental health and realizing that the mental dimension deserves at least equal, if not greater, attention than that given to the physical component in order to experience complete well-being is something that can and should be done.
If the terms are the analysers of the times – the signa temporum – vulnerability fits right into their ranks. Etymologically, vulnerability evokes the concept of wounding (vulnus), whether physical or psychological. Different is the concept of fragility. Vulnerable is one who can be wounded, so it is a person who is not necessarily weak. Fragile, on the other hand, is one who can easily break, because his nature is unstable (Achilles was not fragile, but vulnerable!).
Vulnerability is a common connotation of the human condition and has a complex and paradoxical character. Complexity consists in its being universal (all humans are vulnerable) and individual at the same time (it does not affect all people equally). Paradoxicality, on the other hand, consists in the fact that vulnerability is relational and contextual (we are vulnerable in a given context). Moreover, it is society that makes individuals vulnerable, not the other way around; but it is also society that makes it reversible – if it wants to – by appropriate measures that affect the context and its causal factors (social inequality; access to knowledge; territorial disparities, etc.). With greater intensity following the effects produced by the COVID-19 pandemic, mental disabilities, which have always been the last in the economic investment of the health care systems, require to be no longer so marginal in national investment programs.
One relevant point deserves specific consideration. When it comes to people with mental disabilities, a legal-only reading of rights risks being reductive if the expectations, feelings, and desires of such people are not also taken into account. After a long season of policies marked by the protection of people with mental disabilities, we are now at a turning point where a real paradigm shift is required if the goal pursued is that of inclusion. The complex system of responses to the social needs of which the mentally ill people – think, for example, of people with Down syndrome – are bearers must be characterized by marked flexibility and personalization, so as to unhinge standard service models, now obsolete.
Generalizing somewhat, disability is a condition that is much more widespread than people think. According to the latest WHO estimates, people with disabilities are the largest minority in the world: more than 1 billion people, 15 percent of the global population. But what does it mean to have a disability? Over the past 40 years, we have slowly moved away from the idea that disability is a state of illness or a-normality, due to the presence of a physical, intellectual, or sensory dysfunction, and have increasingly embraced the concept of disability as the interaction between the presence of a dysfunction and the barriers posed by the social environment in which the person with that dysfunction lives. This latter definition tells us two important and symmetrical things: the first is that a person’s disabling condition depends on all of us, as part of the social environment, and that we can therefore help reduce or eliminate existing barriers. The second is that the consequences of this interaction, positive or negative, inevitably touch the whole population. That is why ultimately disability affects us all (see the contribution to this Volume by C. Engel).
2. Health of person includes physical, mental and spiritual well-being
The etymology of the English word “health” is derived from Old English wholeness. In other languages, this relation of health to wholeness or soundness is likewise present. But how is wholeness itself to be understood? To be whole is to be intact, to have all of the parts together, to be functioning as a thing ought, to not be missing something essential. If something has a purpose, then wholeness entails that thing is well-functioning, but wholeness extends beyond being well-functioning; it also includes the notion of being intact. To what extent can the idea of wholeness be used to understand mental health?
As suggested by Vanderweele (2022), many of the disputes around health can be resolved by simply acknowledging that the word “health” is used in two related, but distinct, senses. There is a narrower conception of health that is focused on the health, or wholeness, of the body. However, there is also a broader conception of health that we might refer to as the health of the person, or the wholeness of the person. These two concepts of health are, of course, inter-related. As will be developed further below, the health of the person is in part constituted by the health of the body. Moreover, numerous aspects of the health of the person, such as psychological well-being, do often have effects on the health the body. (For recent reviews of the empirical evidence of effects of psychological well-being on physical health see: Hernandez et al. 2018; Steptoe, 2019). The relations between health of the body and health of the person are perhaps especially complicated when it comes to questions of mental health. The relations and distinctions are also important when it comes to trying to understand the scope and limits of medicine.
In any case, neither of these approaches to defining health is adequate without an account of what the human body or the human person is meant to be, i.e., without some conception of its nature. Some of the disputes around the definition of health thus likely also pertain to competing accounts of human nature (T. Vanderweele, 2024; Messer, 2013). That is why it is proper to take action in order that the “Resolution concerning decent work and the social and solidarity economy” taken by ILO on June 12, 2022 should include explicitly the term “disability”. If such a proposal would be accepted, point 1 in the Conclusions of the Resolution would read as follows: “Guided by the Declaration of Philadelphia in the Constitution of the International Labor Office (ILO), which affirms that all human beings, irrespective of race, disability, creed or sex have the right to pursue both their material well-being and their spiritual development in conditions of freedom and dignity, of economic security and equal opportunity; and that the attainment of the conditions in which this shall be possible must constitute the central aim of national and international policy” (Italics added).
Development is not a single linear and progressive (or retrograde) process, but an extremely complex interaction of several global and local processes. Population growth, urbanization, rising literacy and schooling levels, economic restructuring, changes in production technologies, the “information revolution”, the distribution of military resources, the weakening of the state, fundamentalist religious movements, the dissolution of family structures, and a long series of changes in local cultures and customs are inseparable from development processes. Each of these aspects has implications for overall mental health, some positive, some negative, and the result is a complex social distribution of social and psychological pathology. Simple models that attribute social diseases to either underdevelopment or rapid development do not lead to any breakthrough in their understanding.
Although research does not indicate a simple, direct relationship between economic development and mental health, poverty and deep-seated inequalities are clearly decisive risk factors for almost all forms of psychiatric and social morbidity. Poverty exacerbates existing problems and leaves individuals and communities with few resources to cope with, especially in parts of Africa, Latin America, the Caribbean and Asia. Unfortunately, rapid economic development is not a sure remedy. Development often creates poverty alongside well-being, laying the groundwork for the social origins of suffering for many people on the one hand improving living conditions for some on the other. New forms of poverty, along with the social ills they produce, are challenges to social justice and human rights. Only when economic development is combined with a general concern for justice and human rights can it eliminate a major source of new morbidity. Although no single model or general theory can explain all social, behavioural and mental health problems, researchers have identified a number of causal pathways that may be useful in developing intervention strategies.
3. The case of mentally disabled people
Since the Ottawa Charter in the 1980s, the World Health Organization (WHO) has proposed a model of health “that values social and individual resources”, describing the conditions necessary for effective health promotion; the development of appropriate public policy, the creation of supportive care environments, the reinforcement of community action, and a reorganization of health services that, in addition to the provision of care, includes education regarding protective and predisposing factors for well-being. In line with this approach and following alarming reports on the psychological, emotional, and economic burden of disabilities on families, communities, and health care systems, WHO and the European Union (EU) have long placed mental health among their priorities. With greater intensity as a result of the effects produced by the COVID-19 pandemic, mental illness, which has always been last in the economic investments of health care systems in all Western countries, demands that it no longer be marginal in national investment programs. There is an absolute need to strengthen integrated public policy planning in the knowledge that, even if mental illnesses are not the most prevalent, they certainly entail a very high care burden, on sick people and also on the community that cares for them. Consider the paradox: the huge savings generated by the closure of the costly network of psychiatric hospitals led to the idea that savings could be made on mental health. This is the great betrayal that has taken place in recent decades. For example, the European Union sets 10% of the National Health Fund as the minimum level of spending that each country should devote to mental health. (In Italy, it barely reaches 3% and in no European country is that target met). Recall that care is about social inclusion, rehabilitation and prevention and not simply about a chronicizing medicalization of mental disorder.
The World Health Report (WHO, 1997) listed the ten leading causes of morbidity and the ten leading causes of disability. No psychiatric disorders appear in the mortality table or even in the morbidity table. Yet, in terms of chronic disability, mental disorders constitute the most important single cause. A recent survey by the Harvard Centre for Population and Development Studies indicates that depression is the fourth leading cause of Disability Adjusted Life Years (DALYs) lost in 2000 worldwide. Essentially, a quarter of the total DALYs lost were attributable to mental and behavioural disorders. By 2025, depression will be second only to ischemic heart disease as a cause of the global burden of disease. Despite all this, mental health does not appear on international health agendas. Although the burden of disease resulting from psychiatric and behavioural disorders is enormous, it is severely underestimated by conventional public health statistics because they aim to focus on mortality and not also morbidity or dysfunction. Deaths are traditionally attributed to their immediate causes, rather than to the underlying behaviours or disease conditions that lead to the ultimate crisis. Thus, for example, even when suicide is due to depression or schizophrenia it is classified simply as suicide.
Let me pause a moment to suggest that the Disability Adjusted Life Years (DALYs) criterion that has emerged in the international health policy lexicon as a new measure of the “burden of disease” poses some delicate problems. Developed as a tool for policy-making to measure the impact of disease and to establish the success or failure of policy interventions. (Murray, 1997). DALYs combine time lived with a disability and the time lost due to premature mortality. Years lost from premature mortality are estimated with respect to a standard expectation of life at each stage. Years lived with disability are translated into an equivalent time loss by using a set of weights which reflect reduction in functional capacity, with higher weights corresponding to a greater reduction. In both cases time spent in the lived is adjusted using a set of value choices which weight time lived at different ages and at different time periods differently. Because DALYs are defined in terms of time lost, they are “a bad” which should be prevented and minimized. Yet, more than a life-year (even adjusted) should be regarded as a “good” which should be maximized and not minimized. This is the main reason why the conceptual basis for DALYs is flawed and morally dangerous.
Development policies must protect and promote mental health. This includes: assisting governments in formulating national mental health programs; improving the representation and protection of basic human rights for patients with mental disorders; taking into account the views of users and their families when making decisions about mental health. It should be remembered that the number of people with major mental disorders will increase in the coming decades, and this is for two main reasons. The first is that the number of people living in the age at risk for this illness is increasing. The second reason is that rates of depression have risen in recent decades and will continue to rise as a result of the pattern of economic growth that has been emerging as a result of globalization and the digital revolution. Today we are able to document that the endemic increase in social inequality; the scarcity of relational goods; and the cultural spread of the competitive principle to the detriment of the cooperative principle are among the major causal factors in the spread of mental disabilities.
A short paper published in The Lancet (2023) explores work-related causes of mental health conditions and has some striking findings. For example, the job strain model (a combination of high job demand and low job control) is the model most robustly associated with the onset of depressive disorders. Among the specific working conditions assessed, exposure to workplace bullying is associated with the greatest risk of depressive disorders. Macintyre (2001) has written that humans are “dependent relational animals”. To what extent is our society able to understand and protect this dependence? To what extent are we able to translate a biological fact into a cultural model that implies a definitive ethical framework? Clearly, this is not just about economic dependence, but more importantly existential dependence. Dependency, from an ontological dimension that is the foundation of morality, has become a kind of stigma that fuels social exclusion. It is not only old people, but also the disabled and the mentally ill. Each with their own place of exile: the hospice, the hospital, the asylum. How not to perceive in the ideology of compassion, which lies behind the many forms of care, a not too veiled form of contempt? (Relevant, in this regard, is the notion of aporophobia, in Adela Cortina’s sense).
Remarkable is the reference contained in the encyclical letter Fratelli Tutti, in the paragraph devoted to “Social Discard”, where we read that the principle is being affirmed that certain parts of humanity are expendable when “not yet needed” (this is the case of the unborn), or “no longer needed”, as is the case with the mentally ill and the elderly. The culture of discard stems from a paradox: technical progress has made it possible to improve the quality of life, and increase life prospects, but it burdens society with problems it is unable to deal with. A new form of vulnerability emerges that is based on the “sickness of wellbeing”. If getting sick is a guilt, continuing to live can also become a guilt. Hence the impulse to suicide. It is a “modernized poverty”, as Ivan Illich wrote, that is the result not of scarcity but of the excess of resources from which descends the singular phenomenon of “counter-productivity”: the corruption of the best begets the worst. The marked improvement in health care provision, and food availability has resulted in abandonment, impatience with new burdens, and concern about rising costs.
This gives us an account of a novelty in recent technological development. Robot companions, family robots, personal assistants, care-robots, socially assistive robots are taking the place of humans in caring for the mentally disabled and other categories of disabled people. Now, while the benefits of these “caring machines” must be recognized, some perverse effects, such as the risk of increasing the isolation of those who are already alone, cannot be overlooked. Meanwhile, social and neuropsychiatric problems do not appear in the official agendas of many international agencies and ministries of health. International agencies and national ministries have shown relative indifference to mental health issues. Until recently, international health experts excluded much of this field from standard assessments of overall health. As a result, allocations in national health budgets to prevent and treat these problems are disproportionately low in relation to the human health risks they pose.
4. On the disability employment gap
The most recent data (Atanasova, 2023) on the disability employment gap show that persons with disabilities are persistently disadvantaged in the labour market compared with persons without disabilities. Between 2014 and 2022 in the EU27 this gap ranged from 22.7 to 21.4 percentage points. And in spite of the fact that quality employment for people with disabilities has been on the EU agenda for more than decades (reasonable accommodation for people with disabilities in the employment market was introduced by the Equality Framework Directive 2000/78 in 2000), the United Nations Committee on the Rights of Persons with Disabilities (UN CRPD) has recurrently raised concerns about high unemployment among persons with disabilities in the EU (UN 2015), as well as about the labour market conditions for persons with disabilities working in segregated sectors (Priestley 2021). A recent special report of the European Court of Auditors on the impact of EU action in supporting people with disabilities also concluded that “no significant improvement in recent years” is seen with regard to the disability employment gap.
As Atasanova (2023) courageously points out, despite enlargement of the legislative framework at EU and national level aimed at protecting people with disabilities from discrimination in employment, and at providing reasonable accommodation when such is required, the disability employment gap has not shrunk significantly. A dedicated flagship initiative, the ‘Disability Employment Package’, incorporating a list of set actions, is included in the new EU Strategy for the Rights of Persons with Disabilities 2021-2030 (EDRS), which is one of the EU’s continuing efforts in this direction (see also, in this regard, the specific considerations advanced by A. Barrera in his contribution to the present volume, “Economic inclusion of person with disabilities”).
The above applies to disabled people in general. But what can be specifically said for the mentally disabled? In February 2022, Sam Altman invested significant sums in Mentra, a startup created by three autistic people, with the aim of using AI to help large information technology companies hire workers with dyslexia, attention deficit hyperactivity disorders, or Asperger’s syndrome. Altman, the father of ChatGPT, knows well both the potential of AI and the troubling lack of talent needed to work with it. Manpower informs us that the world today lacks 78% of the tech talent that AI needs. It begs the question: why look for these personnel among those who are neuro-divergent? The social enterprise Auticon – whose president is Alberto Balestrazzi – answers that people with neuro-diversity have characteristics-attention to detail, high concentration even on repetitive tasks, and precision in problem solving – that prove very useful for information technology projects. Auticon, founded in Berlin in 2011, now operates in 14 countries selling neuro inclusion services to large companies. The more than 400 neuro divergent workers occupied in Auticon, have above-average logical intelligence that enables them to develop information technology projects more efficiently than neurally normal people. They are also incapable of lying, a quality that makes them well suited to work on sensitive data in sensitive areas such as cybersecurity.
In March 2022, the world’s largest professional platform, LinkedIn, listed dyslexic thinking with distinctive qualities. Credit for this breakthrough that shatters many stereotypes about people with diversity goes to Kate Griggs, founder of the nonprofit organization “Made by dyslexia”. In her view, dyslexics are born explorers and thus well suited to stimulate AI to grasp the crux of a question and respond with the most useful information. For example, in pattern recognition, neurodivergents have above-average abilities. In March 2022, the report “AI and the Rights of Persons with Disabilities” was presented to the UN Human Rights Council. The special rapporteur, Gerard Quinn, denounced the fact that people with disabilities are at risk of being rejected for a particular job without even considering their merits or without considering that with a simple aid they would be able to do the required work. Hence the suggestion to hire AI developers who have experienced or are experiencing disabilities. And this is in accordance with the motto of the United Nations, “nothing about us without us”. That is to say that people with diversity should not simply be listened to in order to take into account their perspectives, they must also be involved in their development. And this is so in order not to transfer onto machines the implicit prejudices related to emotions, prior experience, and external conditioning.
Enthusiasm for the possibility that AI opens wide and for the role as protagonists and not just passive beneficiaries that people with diversity can play is spreading, especially among those working in neuromuscular and neurodegenerative diseases. People are beginning to talk about disability as an empowering element of technology research. In short, a major shift is taking place: diversity is proving to be a key competency in the current technology transition. Manpower (The Talent Shortage Report, 2023) suggests that people with disabilities have an expertise to spend on the human-machine relationship front. Indeed, those who live first-hand with an aid have an embodied experience of it, which they can describe much better than those who have not gone through a similar process, because they know what it is like to live with a machine. This is why people with disabilities must be included in the construction of social robots, capable of artificial empathy (see Bennett, Gibb, 2021, where the Authors defend the thesis of diversity as a value).
In a very recent and authoritative piece of work, Abramson et al. (2024) develop an economic theory of mental health. Based on classic and modern psychiatric theories, they model mental illness as a state of negative thinking and rumination which are reinforced through behaviour. Agents who experience mental illness have pessimistic expectations of future productivity, risky returns, evolution of mental health and loose time due to rumination. As a result, they work less, consume less, invest less in risky assets, and forego treatment. Which, in turn, reinforces their mental illness. The Authors use their model to evaluate the welfare costs of mental illness and the effect of mental health policies. They conclude that expanding the availability of mental health services substantially improves mental health services and welfare. In contrast, reducing the out-of-pocket cost of mental health services has minimal impact. A similar approach has been followed by a team of researchers (Lund et Al. 2024) who empirically find that treating mental health conditions substantially improves recipients’ capacity to work in an effective way.
5. Ways ahead. Mental health in the perspective of community welfare
The social transformation of the past three decades intersects with the profound crisis of the welfare model that still prevails today. What emerges from the res novae of the present era is the need for a comprehensive readjustment of welfare systems capable of overcoming outdated protection schemes and at the same time being financially sustainable. The new proposals of social investment call for abandoning a centralized model of public intervention (welfare state) in order to experiment with different forms of community welfare in which the univocal relationship between the public system and the welfare state is overcome. Basically, the community welfare is a relational service model (see Donati in this volume). In addition to the public, private agents (individuals, families, Third Sector organizations) are also called upon to play a relevant role at the allocative and redistributive level, in homage to the principle of subsidiarity.
The initial response to the crisis of the welfare state in the 1990s was a neoliberal model known as the welfare mix, in which public agencies retain the monopoly of commissioning but give up, in whole or in part, the direct provision of services in favour of their provision by private producers through increasing outsourcing. In the last 15 years, however, dissatisfaction with the results generated by the welfare mix has led toward the construction of a plural welfare model, known as community welfare, in which civil society actors are also given the power to participate in the process of planning interventions and not only in the process of designing them. From the point of view of the services offered, community welfare differs from welfare state and welfare mix because, unlike the former, it does not offer standardized services and, unlike the latter, it does not offer services that tend to favor the privatization of the service, resulting in fragmentation and isolation. (See Ugolini, 2023).
A few examples to clarify the differences between these models. While the response of the welfare state to the need for assisted living of the mentally ill has been predominantly the admission to nursing homes, creating socially isolationist situations of institutionalization, the response of the welfare mix, on the other hand, has been the provision of home-based services, which has caused isolation and the spread of the phenomenon of assistentialism. In contrast, the community welfare response is a different idea of housing, which includes multiple forms of co-housing (such as family-homes) and social street experiences. Over the past two decades, mental health services have built pathways for taking care of mental patients that involve clinical, rehabilitation and social inclusion aspects, with an approach to long-term care typical of the chronic dimension that mental health problems often entail. Another important example is that concerning health budgets, a social-health integration tool to support the Individual Therapeutic Rehabilitation Project of people with severe mental disorders, consisting of individual, family, social and health resources networked in order to improve the person's inclusion and active participation in the community.
In essence, it must be acknowledged that the care of the mentally disabled cannot take place in a disjointed manner from the care of the bodies of those same individuals. Unlike physical disability, which requires the already difficult definition of pathways of integration between health and the social dimension, mental disability, influenced by genetic predisposition, socioeconomic background, negative experiences during childhood, alcohol and drugs, requires to systematize not only health and social policies but all policies for the definition of a comprehensive approach that cannot absolutely disregard the involvement of the community in which the mental distress manifests itself.
One point on which there seems to be a consensus is that neuropsychiatric disorders are biosocial – that is, that both biological and social factors are involved. Mental disorders are not simply symptoms of broad social conditions. They also reflect an inherited vulnerability and are mediated by neurophysiological processes. However, the quality of a person’s social environment is closely related to the risk of suffering from a mental illness, whether an episode of illness is triggered, and the likelihood of that illness becoming chronic. For example, a deficiency of essential trace elements in childhood associated with malnutrition, poverty and uprooting leads to neurological deficits and brain dysfunction. Schizophrenia is not a “social disease”; however, social and cultural factors strongly influence the course of the disease and the likelihood of recovery. Epilepsy is a consequence of brain pathology; why 90% of epilepsy patients in several Asian and African societies do not receive any proven biomedical treatment is a social problem. Although neurotransmitters are implicated in major depression, trauma in childhood, such as the loss of a parent, increases lifelong vulnerability to depression; significant loss, violence, and trauma play an important role in triggering specific depressive episodes, especially when experienced by relatively helpless people with few personal and social resources.
What to do to meet the challenge? One thing is clear. For the many and varied proposals to be taken seriously and implemented, there must be an international movement that prioritizes mental health. There is no doubt that a worldwide consensus such as that organized on democratization will determine substantial pressure to get all societies to rethink priorities and practices. It is essential that similar international attention be given to mental health issues by international agencies such as the United Nations, the World Bank, the World Health Organization and regional organizations such as ASEAN, the Organization of African Unity and the Organization of American States. It is essential, in short, to raise the international level of awareness that will condition the priorities that policymakers and those who develop them in countries around the world assign to mental health. Such a global campaign for mental health should involve the media, businesses, educational institutions and networks of those who design health and social policies (on the topic above, see the classic work by Desjarlais et al., 1995).
6. A concluding remark
The distress that comes from many tragic events and cases of destitution leads us to consider careful the notion of “social inclusion” and to identify in with the litmus test of the seriousness of our declarations. To include means sharing, participating, moving from being a stranger and misfit to being an integrated and active person, from a subject to a sovereign citizen. Above all, inclusion means, today, to consider that in the last decades there has been a sharp growth in the number of people that have been warehoused, displaced, trafficked, reduced to mere labouring bodies and body-organs. The Princeton economist Anne Case and Angus Deaton (2020) suggest that recent patterns of mortality and morbidity go hand to hand with exclusion from marriage, children, religious congregations and political society.
Social inclusion can take place only on the grounds of the formal recognition of equal opportunities to participate in the strategic decisional and operative moments that make a social aggregate an active civil society, polyarchic and solidaristic. It should never be forgotten that the principle of inclusion does not originate in satisfying debts by exchange or distribution. Distribution operates within an already given social inclusion. One does not become a member of society by the fact of being given something. Already pope Leo XIII worried that all of the so-called “necessary societies,” would be gradually reduced “to the genus of commercial contracts, which can rightly be revoked by the will of those who made them” (Humanum Genus, April 20, 1884, no. 21).
It is noteworthy that the distinguished demographer N.N. Eberstadt has coined the expression “our miserable 21st century” to indicate that miseries arise not so much from plagues and natural disasters as from exclusion from the basic social forms of living-together. (“Our Miserable 21st Century”, Comm., Feb.15, 2017). Needless to say, the spread of such a mentality is the result of the disappearance of the principle of fraternity from our cultural horizon. It was the Franciscan school of thought that gave the fraternity principle the meaning it has kept over time: that of complementing and at the same time transcending the principle of solidarity. In fact, where solidarity is the social organizing principle that enables unequals to become equals, fraternity is the social organizing principle that enables equals to be diverse. Fraternity enables people who are equals in dignity and with the same fundamental rights to freely express their life plan or their charisma. The past centuries, the 19th and especially the 20th, were characterized by major cultural and political battles in the name of solidarity, and this was certainly a good thing; think of the history of trade unions and of the civil rights movements. The point is that a good society cannot content itself with the horizon of solidarity, because while a fraternal society is also one of solidarity, the opposite does not necessarily hold true.
Having forgotten that no human society is sustainable where the sense of fraternity is extinguished and where everything is reduced, on the one hand, to improving transactions based on the exchange of equivalents principle and, on the other, to increasing transfers by public welfare institutes explains why, in spite of the quality of the intellectual resources deployed we have not yet come to a credible solution of the great trade-off between efficiency and equity and that between negative and positive liberty. The society in which the principle of fraternity is dissolved is not capable of a future; in other words, a society where there exists only “giving in order to get” or “giving out of duty” cannot progress. Gift-giving as gratuitousness, i.e. fraternity, is the experience of a non-functional, non-mechanical reality in a world that tries to exclude, to eliminate, all that is non-functional, all that is gratuitous. This is why neither the individualist vision of the world, where everything (or nearly everything) is trade, nor the Hobbesian vision of society, where everything (or almost everything) is duty is a safe guide to lead us out of the shallows in which our societies are grounded today.
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