Monday, 15 May 2017

Franco Basaglia, Democratic Psychiatry & the Closure of Psychiatric Hospitals in Italy

"Many were seduced by Basaglia’s intellect and his personality (including those who had never met him). He was charismatic and charming, and he inspired love and admiration, but also fear, jealousy and sometimes hatred. He became a hero to many, but also an anti-hero for those who were opposed to the movements linked to 1968 (as well as for some who were key figures in ‘1968’ itself). In 1968, he became a symbol for a whole epoch overnight, a household name. A key law was later named after him, a rare honour in Italy, especially for a non-politician."
John Foot (2014)

Franco Basaglia (1924-1980) - "the most influential Italian psychiatrist of the 20th century" - studied medicine and surgery at the prestigious university of Padua and spent the years after his graduation studying the philosophical ideas of Sartre, Husserl, Heidegger, and Jaspers, as well as critics of psychiatric institutions such as Michel Foucault and Erving Goffman. He worked at university and specialised in the field of "nervous and mental diseases", then left university as he was "too sharp, too unorthodox, too original, not servile enough" to progress within the university system. Basaglia left and became the director of the provincial asylum of Gorizia which had about 500 patients (after this position he became the director of asylums in other cities). When he arrived at the Lunatic Asylum of Gorizia in 1961, he was "revolted by what he observed": locked doors, straits jackets, ice packs, bed ties and insulin-coma shock therapies in response to human suffering. Basaglia refused to bind patients to their beds and abolished isolation methods. He introduced democracy within the asylum: doctors did not wear white coats and mingled with patients, locked wards were opened, bars and strait-jackets were removed.
Thanks to his initiative, a debate started all over Italy that finally resulted in a paradigm shift seeing recovery as participation and citizenship, a shift that led to the gradual closure of mental hospitals. The so-called "Basaglia Law" (Law 180, Italian Mental Health Act) was passed in 1978 which restructured mental health care and closed all psychiatric hospitals in Italy.

Basaglia's main criticism was that psychiatry's approach was to oppress persons instead of curing and liberating them. He was convinced that  the entire asylum system was morally bankrupt and reducing inmates to "non-persons" or "hollow men" (via and via and via and via).
"We want to change the pattern that makes the patient a dead body and strive to transform the dead mental patient in the asylum into a living person, responsible for his own health." Franco Basaglia, cited in Roberto Mezzina
For Basaglia, stereotypes of madness were consequences of institutional conditions. In other words, some eccentric behaviour patterns were exacerbated or even created by the institutions themselves. Inmates were "the excluded", a "deviant majority" that was interned against their will and broken down by this very system. Psychiatric hospitals were prison-like, oppressive institutions. Both architecturally and functionally they were similar to prisons. Basaglia himself, by the way, had spent six months in prison after being arrested for being an anti-fascist activist  (via and via).
This was a collective ‘no’. And this ‘no’ changed the world. It was not acceptable to treat people in that way – without rights, without autonomy, without knives and forks, without hair, without any control over their own treatment. It was wrong to electrocute these people, cut out bits of their brains or tie them up for years on end. This movement was a struggle for liberation, for democracy and for equality. These 100,000 inmates of mental asylums had disappeared from history.
They needed to re-emerge – to be given back their own identity and dignity. This generation of politicians and psychiatrists was a post-war, anti-fascist generation. There was something profoundly anti-fascist about the anti-asylum movement. It was a movement about human rights. The people inside the asylums were people.
John Foot (2014)

"Democratic Psychiatry", created by Franco Basaglia, was never "antipsychiatric" but a movement to liberate the ill from segregation in mental hospitals (via). Its implementation was and is not easy and it is debated to what extent the reform has made changes in the general picture of psychiatric care (Palermo, 1991). Literature on Basaglia either tends towards idealisation or demonisation portraying him as a secular saint or an irresponsible radical (via). Basaglia was not a saint but he surely "helped to transform the way we see mental illness" and it was his work that "saved countless people from a miserable existence". His "legacy persists, as an object lesson in the struggle against the brutality and ignorance that the establishment peddles to the public as common sense" (John Foot, 2015).
The history, biography and practice of Franco Basaglia and the psichiatria democratica (democratic psychiatry) movement he partly led and inspired has, with a few exceptions, been consistently misinterpreted in the English-speaking world (and in particular in the UK, although one exception is Ramon, 1988). Let us take, for example, the judgements of two of the leading historians of ‘madness’ and ‘asylums’. In 2002, Roy Porter wrote: ‘In Italy, leadership of the movement was assumed by the psychiatrist Franco Basaglia, who helped engineer the rapid closure of institutions (chaos resulted)’ (Porter, 2002: 210). In 1994, Porter referred to Basaglia as ‘Enrico Basaglia’ and labeled him as a ‘boisterous anti-psychiatrist’ (Porter and Micale, 1994: 20). Andrew Scull’s judgement on Basaglia was similarly brief, in 2011: ‘In Italy, led by the charismatic Franco Bassaglia [sic], the political left led the charge’ (Scull, 2011: 113). A more balanced and well-informed account (although with some errors) can be found in Burns (2013: xlvi, 148–9, 183). However, even here, Basaglia is described as a ‘Gramscian Marxist’.
The origins of these snap and inaccurate judgements lie in a series of areas. First, Basaglia’s work was not translated into English, including (and most importantly) L’istituzione negata (Basaglia, 1968). This book was, however, quickly translated with success into numerous other languages.
John Foot (2014)
“Tomorrow morning, at visiting time, when without any lexicon you try to communicate with these men, you will be able to remember and recognise that, in comparison with them, you are superior in only one way: force.”
Franco Basaglia

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photographs via and via