It’s called the “Italy Syndrome”: it’s the umbrella term used to refer to a set of symptoms and clinical signs of sometimes debilitating psychological suffering and mental health issues, ranging from depression, anxiety, insomnia and lack of appetite, to hallucinations and obsessive or paranoid behaviour, to suicidal ideations and attempts. The term first emerged in the 2000s, a formula of Andriy Kiselyov e Anatoliy Faifrych, Ukrainian psychiatrist that had identified and observed these common symptoms in several Ukrainian, Romanian, Moldovan and other Eastern European migrant mothers, but also Filipinas or South Americans. All of them shared a specific story: for years they had lived as labour migrants in Italy or in other Western European Countries, such as France, Spain and Germany; employed – often illegally – as domestic helpers and family assistants or caregivers for the elderly, being separated from their families and children.

In general, the disease manifests itself upon return home, after many years of absence, facing reintegration into the family and the country of origin. The long absence, and the sense of detachment and loneliness it causes, leads to a radical fracture of identity and a guilt-charged fading of their sense of motherhood and belonging.

The provocative name of this condition refers to Italy being the largest importer in Europe of paid caregiving. As stated in the First Annual Report of Domestic Work – a 2019 publication of the National Observatory of Domina (National Association of Families Employers of Domestic Work) – Italy employs about 2 million domestic workers, more than half employed illegally. About one million carers are from Romania, the largest portion being females. In addition, according to the 2019 Migrant Presence Report of the Italian Ministry of Labour and Social Policy, there are about 125,000 Moldovans and 350,000 Ukrainians legally residing in Italy, of whom respectively 66.6% and 78.8% are women. Some estimates accounting for irregular migrants cite 500,000 Moldovans and 1 million Ukrainians.

This trend is a direct result and undoubtable consequence of the so-called ‘Mediterranean’ or ‘family’ welfare model, prevalent in Italy (a worryingly aging country), that relies heavily on family networks as the main social safety net. In reality though, rather than a “family” welfare model, the data portrays perhaps a “female” welfare model: according to the International Labour Organisation, 74% of unpaid care in Italy is performed by women. In addition, about 90% of domestic helpers and carers are also women. Not only that, but the work of caring is mainly passed on to the poorest women, either because they do it for a living or because they cannot pay someone else to do it for them. This of course opens up employment opportunities available for labour migrants, particularly if female and coming from Eastern European countries.

As anthropologist Donatella Cozzi stated during a BBC radio programme, there is a combination of multifaceted reasons for these migrants to develop the condition of “Italy Syndrome”. For starters, their biographical history, also in terms of cultural and socio-political origin, can provide some insight. In countries such as Romania, Moldova and Ukraine – among the many transformations and shifts that came about after the fall of communism and the change of system – there has been an increased feminisation of labour migration, of mothers leaving at home their children, their aging parents and very often a husband unable to find employment. Suddenly, this caused a reversal of traditional gender roles, dismantling the status of mothers as mere procreators and seeing them become the main financial provider. Of course, there are no means for us to determine if these women would have suffered mental health problems even if they had stayed at home. But it is for certain that migration is a transformative process; and during this very difficult process, there might be some preexisting problems that are magnified or even issues directly induced by the stresses faced as migrants, workers and mothers. Psychological disorders aren’t born in a vacuum: nostalgia, worrying about those left behind, the need to work at all costs, the pervasive issue of alcoholism and at times abandonment of children from the husbands back home, are all contributing factors. One more element to mention that is specific to these women is the fear of being reported to the authorities. Their societies of origin used to be highly policed and surveilled, so anybody could inform against you. Having been raised in such an environment can weigh heavily upon these women, especially if they find themselves in situations of irregular migration or are working abroad illegally.

More importantly though, it is essential to analyse the type of work that these women do as caregivers or “family assistants” for those unable to care for themselves. It is a challenging profession in itself, but it is aggravated by the working conditions: especially if the elderly person suffers from serious neurological degenerative diseases, such as Alzherimer’s or dementia, cohabitation of the carer is required, often 24-hours a day, 7 days a week. In this case, the threat of labour exploitation, psychological and physical violence, harassment and abuse is still pressing, particularly for illegal migrants or irregular workers, leaving the carers to live in an almost servile status and sometimes inhumane conditions. These circumstances are combined with a failure in the integration into the social fabric of the receiving country and a lack of access to all kinds of services and social spaces needed to lead a normal life outside of work. In addition, both the issue of reunification of families and the problems parents and their left behind children face are still insufficiently addressed in Italian public policies and in the political agendas. In fact, cohabitation implies that the carers may not be granted any rest days or any time for a leave of absence to go see their children; living in the same household that employs them also means that they have no chance of bringing their children for visitation or an eventual reunification.

The issue is undeniable and pervasive, becoming increasingly present in the foreground of the public (and artistic) discourse on migration and parenthood, and not only in journalistic articles and in scientific literature. The appropriately titled graphic novel “Sindrome Italia” by Tiziana Francesca Vaccaro, with illustrations by Elena Mistrello published by Becco Giallo in 2021, is the first-person account of the years that the protagonist Vasilica, a Romanian migrant, spent in Italy, in Palermo and Milan, and of her bitter return home, of the scars that migration brought along, of a femininity engaged in a perpetual struggle. The novel is the adaptation of a one-woman theatre piece written and performed by the author and actress Tiziana Vaccaro, integrated by the results of theatre workshops she coordinated. While looking for a story to tailor for a new play, Tiziana met her neighbours, five women from Ukraine all employed as domestic workers, and started learning about their condition and the challenges they endured. She also met Silvia Dumitrache, founder of ADRI (Association of Romanian Women in Italy), who introduced her to Vasilica. She opened Tiziana’s eyes on the reality of poorly paid work, denied time, anxiety, paranoia and depression, and eventually became the inspiration for the main character of the story, beautifully and dramatically told through this blend of mediums.

The contact point for this interaction, and reference person of many important initiatives, Silvia Dumitrache, has been at the forefront of trying to bridge Italy and Romania on the issue of migrant mothers and transnational families. On the point of the Italy Syndrome, she stated: «2.5 million people in the EU are employed in the domestic sector and 88% of these are women, who in most cases have left their children at home, thousands of kilometres away. They are women who suffer, psychologically and socially, from a socio-medical syndrome, known as the Italy syndrome: depression, feelings of guilt, loneliness lead some to attempt suicide. They are invisible people, who do not even appear in the PNRR (ed. National Recovery and Resilience Plan), the Plan that should put care at the centre: of the planet, of the family, of the person. The Plan makes reference to the vulnerable and the elderly and dedicates an important fund to them: but it is fundamental that those resources for care are also linked to ‘those who care’». She then added: «In Italy institutionalised exploitation takes place […]. The problem? The lack of welfare. This exploitation is not the fault of the families: it is the State that does not fulfil its obligation to guarantee the dignity of these workers. You cannot turn a family into an entrepreneur, or a business, without preparing them. It is not right that these families should find themselves giving their money to the carer, as if they had to ‘buy’ that person and become, in some way, their master. We need a mediator, a figure that is not a private agency, but comes directly from the State». On the absence of proper legislation and institutional support from the Italian State, Adriana Patrichi, activist for the rights of Romanian women, has stated: «That is the reason those of us trying to understand and help these people, often find ourselves unable to set up support projects that include preventive measures. This phenomenon affects not only the individual but also society. Without urgent attention and measures, we run the risk of dealing with a dangerous social tragedy».

Patrichi also mentions that the Socola psychiatric hospital, located in Iași, is the only establishment in Romania studying this phenomenon, aiming to turn the spotlight on this sensitive issue that is also neglected by the Romanian authorities. This facility has been the destination of an important journalistic reportage, carried out by Francesco Battistini and published in 2019 in the Italian daily newspaper “Il Corriere della Sera” in its online format, bringing more attention to the issue from Italian media. The article reports an almost untranslatable name for a feeling that all the carers know, “dor”: the longing for what has been abandoned, the yearning for what will never be found again, the anxiety for so much suffering to end. It is reported that one third of the patients try to commit suicide at least once, and many succeed. But it is a silent massacre, because the family often asks for the death certificate to be changed: the Church denies funerals and a Christian burial to those who take their own lives.

On the other side of the coin, the Italy syndrome also affects the 750,000 left-behind children of carers, the so-called “white orphans”. Those left behind suffer in various ways: anger, anxiety, learning difficulties. The article reports «There are those who are ashamed because their mother is away. Some live with grandparents, but they are too old. Others with neighbours, but they are too much like strangers. Still others are left to fend for themselves. Parents sometimes go to Italy and fail to leave someone in charge of their children». Silvia Dumitrache explains: «Children left behind in Romania think they have been abandoned. They wait for their mother to return, but years go by and this absence kills them little by little. Sometimes even literally». Dumitrache keeps track of the number of children who commit suicide, unable to bear abandonment: about a hundred to date.

Tatiana Nogailic, founder and president of Assomoldave, the first association of her Moldovian community in Italy, shares: «In my country, it is mainly males who take their own lives. Boys hang themselves, little girls poison themselves», adding «It is the sacrifice of a generation of women for the well-being of their families, who then often repudiate them». As Dumitrache has stated: «It is the paradox of women who have sacrificed themselves to support their families and give their children a better future, but ultimately it ends up destroying their own families».


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  • BBC Sounds, “Romanian Women Suffering from “Italy Syndrome”” – BBC Weekend (16 February 2019)
  • Chiara Ludovisi, “Lavoro di cura: uno “status comunitario” e figli sempre con sé. Appello per il 1° maggio” – Redattore Sociale (30 April 2021)
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