Italy's Psychiatric Renaissance

COMMENT BOOKS & ARTS

MENTAL-HEALTH CARE Italy’s psychiatric renaissance Andrea Tone admires the history of a radical shift in the treatment of mental illness.

p to the 1960s, people in Italy’s The Man Who Closed asylums were stripped of their pos- the Asylums: Franco sessions and personhood: victimized Basaglia and the Uby rigid rules, overcrowding and filth, tied to Revolution in Mental beds or caged and separated from the outside Health Care JOHN FOOT world by towering walls. By the late 1970s, the Verso: 2015. landscape had been transformed by a reform movement led by ‘critical psychiatrist’ Franco Basaglia. Historian John Foot explores this extraordinary revolution and its legacy in and especially Trieste. Basaglia’s work there The Man who Closed the Asylums — first pub- culminated in its asylum’s closure in 1980 — lished in Italian as La “Repubblica dei Matti” the year that Basaglia died of a brain tumour. GIUSEPPE PINO/MONDADORI PORTFOLIO VIA GETTY PORTFOLIO GIUSEPPE PINO/MONDADORI (The ‘Republic of the Mad’; Feltrinelli, 2014). Trieste became a centre of pilgrimage for criti- The movement, Foot shows, came to con- cal psychiatrists and a model for reform rec- demn asylums as morally bankrupt and of ognized by the World Health Organization. limited therapeutic benefit. Spearheaded by The Man Who Closed the Asylums is radical psychiatrists and joined by journal- ambitious and well researched. It is also ists, intellectuals, patients, activists and poli- detailed and long, packed with block quotes ticians, it laid the foundation for a reform and a large cast of characters, as well as a smat- act, Law 180. Passed in 1978 by health com- tering of case studies of asylums and local missioners rather than Parliament, the law politics, making it an occasionally choppy authorized the de-institutionalization of read. It is less a biography of Basaglia than a patients, the establishment of community- contextualization of the man and the move- based psychiatric services and the closure of ment in a network of historical actors and the asylums. That process finished only in the Franco Basaglia in Colorno, Italy, in 1971. politics and ideology of post-war Italy. late 1990s, but it returned 100,000 patients Foot says little about how patients were to society. For the first time, a broad coali- jukebox), saw films, played sport and gave diagnosed, the spectrum of their disorders tion united in rejection of asylums to parlay voice to their experiences in a patient-run and medical interventions, particularly after its views into a national political mandate. magazine, Il Picchio (The Woodpecker). Many psychiatric drugs such as the anti-psychotic The revolution began in Gorizia. An took day trips and mixed with locals. Patients chlorpromazine reached Italy in the 1950s. isolated city on the border of what was and staff met daily to discuss their care and to Scholars such as Joel Braslow and Andrew then Communist Yugoslavia, Gorizia was debate broader questions. Were reforms the Scull have generated a vast literature on these politically centre-right: mostly Christian goal, or a prelude to closing the asylum? How questions, which Foot sidesteps. Also missing Democrats, with some neo-fascist groups. It should tensions between asylum leaders and is a discussion of what non-asylum psychiat- was an unlikely site to spark a revolution. local authorities — not all of whom embraced ric care, if any, existed in Italy before Law 180. Its asylum, like others in Italy, was “dark having patients in their midst — be resolved? Foot’s argument would have benefited and sinister,” a place of “horror”, notes Foot. In Despite ideological divisions within and from more comparative analysis. Before 1961, Basaglia became its director, primed for beyond the asylum, Gorizia, many North American asylums had change. After spending six months in prison “Small groups Gorizia became introduced reforms. In 1956, for instance, the for anti-fascist politics under Benito Musso- of people in famous. Activists use of anti-psychotics encouraged US public lini’s Fascist government, Basaglia knew how peripheral demanding free- asylums to discharge more people than they institutional power could thwart individual places can dom and societal admitted. Yet, as Foot avers, no country or liberties. His critique of asylum psychiatry change history.” change visited to movement went as far as Italy in recalibrat- was influenced by philosopher Michel Fou- witness “new forms ing the organization and politics of mental- cault and sociologist Erving Goffman, as well of democracy in action”. The Negated Institu- health care. Law 180 (and broader health as psychiatrist Maxwell Jones, whose work tion (Einaudi, 1968), a best-selling book by reforms that soon subsumed it) was unevenly turning UK asylums into open therapeu- the collective with Basaglia as editor, detailed enforced, failed to create a singular model of tic communities gave Basaglia, and his wife the transformation and propelled critical care and was undercut by political opposi- Franca Ongaro, a new paradigm. psychiatry into the national spotlight. tion. Yet Foot’s impassioned story reminds In Gorizia, Basaglia assembled a team — By then, Basaglia and others had come us that the future is neither immutable nor the “équipe” — of physicians and reformers to believe that patients would be better off ordained, and that small groups of people in including Giovanni Jervis and Ongaro, the in communities with decentralized psy- peripheral places can change history. ■ latter of whom Foot credits as the principal chiatric services. He left Gorizia along with author of Basaglia’s myriad publications. By some members of his team, and the “Gorizia Andrea Tone is professor of history and the mid-1960s, the équipe had opened up the diaspora”, along with the popularity of The Canada Research Chair in the Social History asylum. Freed from shackles, patients rose Negated Institution, had a ripple effect. Psy- of Medicine at McGill University in Montreal. and slept when they pleased. They socialized chiatric care was restructured in other Ital- She is the author of The Age of Anxiety. at the institution’s new bar (equipped with a ian cities, including Reggio Emilia, Parma e-mail: [email protected]