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1978-2018. the Basaglia Law Forty Years After Mario Augusto Maieron ASL Varese (Now Agenzia Di Tutela Della Salute – ATS - Dell’Insubria)

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1978-2018. the Basaglia Law Forty Years After Mario Augusto Maieron ASL Varese (Now Agenzia Di Tutela Della Salute – ATS - Dell’Insubria) Medicina Historica 2018; Vol. 2, N. 3: 133-144 © Mattioli 1885 Original article: history of medicine 1978-2018. The Basaglia Law forty years after Mario Augusto Maieron ASL Varese (now Agenzia di Tutela della Salute – ATS - dell’Insubria) Abstract. Forty years after the Law 180 gives the author an opportunity to speak about the changes brought about in psychiatry since 1978 and to assess psychiatry today, in its organisation, expertise, epistemological references, clinical expressions and operative methods in addition to its critical issues. Key words: Law 180, Franco Basaglia, psychiatric renewal, reorganisation of Mental Health Services, sector psychiatry, community psychiatry, residential psychiatry The Law 180, known as the Basaglia Law, is forty fined them, and earlier still, as remembered by Michel years old. Foucault, placed them as diseases of the soul, fruit of It is the law that sanctioned the closing of mental insane passions, in the category of vices (2). asylums, the conclusion of a period, defined by Edoar- Not only Binswanger however. do Balduzzi as “the years of Italian psychiatry”, that go Other phenomenologists such as Edmund Hus- from 1964 to 1978 (1), in which the reform movement serl, with his epoché, Martin Heidegger between phe- was developed and completely modified the prerequi- nomenology and existentialism, Eugène Minkowski sites of care and assistance for persons with psychic with his ideas of time, of Bergsonian derivation and disturbances that were put into practice in the years lived time and Jean Paul Sartre with Being and Nothing- to come. ness, had influenced his thoughts. His merit, however, Alberta Basaglia, psychologist and vice president lies not only in his original re-elaborations of philo- of the Basaglia Foundation, remembering her father in sophic conceptualizations, but also in having brought one of the numerous interviews granted on this occa- concreteness from a practical point of view to his ideas sion, underlined his great merit, besides the organiza- concerning his experiences above all in Gorizia and tional aspects of psychiatry, was that of restoring dig- Trieste and his battle against the mental asylum which, nity to those who had been marginalized and excluded. during the Seventies of the last century together with Franco Basaglia who, in the Padua University MAI (the Anti Institutional Movement), had become Clinic where he had initially worked, was known as the dominating theme of the reform movement ex- “the philosopher”, had his cultural roots in phenom- pressed by official psychiatry and its associations. enology and more specifically in the anthropophe- This is perfectly summed up in the conclusion nomenology of Ludwig Binswanger (and in Italy that given in Wikipedia on his thoughts and way of con- of Danilo Cargnello). They considered mental distur- ducting psychiatry bances, apart from the health-illness antinomies, as as- pects of human presence, creating the prerequisites for […] keep listening and divest yourself of every a radical change in the methods of their confrontation certainty, […] make a suspension, an epochè, of compared to the where and how that positivistic medi- all the sclerotic categories, in order to let the pa- cine, born at the end of the 18th century, had con- tient have his say (3). 134 M.A. Maieron The Law 180 represented the conclusion of his Chamber, which also involved loss of civil rights and battles, it was not, however, his law, even though he registration in a special judicial register. The sentence accepted to give it his name. could be modified only by another sentence and the In parliamentary circles it was a preview of a law problem of the treatment was secondary. It had be- then under discussion in National Health Service in- come relevant for the progress in the therapies made stitutions that also included psychiatry. This had been for some disturbances above all from the Twenties on- promoted by the psychiatrist Bruno Orsini, a Demo wards, but it only had an effect on legislation with the Christian M.P. to avoid holding a referendum pro- Law 431 in 1968 that allowed for voluntary hospitali- posed by the Radicals for the repeal of the 1904 law on zation “for findings and treatment” without the legal mental hospitals that, if rejected, would have proved a effects that were in act for authorized admissions. disaster for the reform projects that would have been The 180 instead cancelled all the legislations set difficult to remediate. It was in fact a compromise be- out in the 1904 Law and always considered the psychic tween those (SIP – Italian Society of Psychiatry – and disturbance as a problem of the person, while laying AMOPI – Association of Italian Psychiatric Hospital down certain principles of reference for the treatment. Doctors-) who intended to eliminate the psychiatric The subject on the findings and the compulsory hospitals by setting upwards inside General hospi- health treatments with ample guarantees on times and tals and those (MAI – Anit-Institution Movement – methods for the persons involved (six articles) was ex- Democratic Psychiatry) who retained even these were plained in greater detail. unnecessary (4). Other matters concern hospital psychiatry, with The law, as far as the closure of asylums was the creation of Psychiatric Services for Diagnosis and concerned, coincided with the ideas of Basaglia. He Treatment (SPDC) in general hospitals which were retained, however, that placing psychiatry inside equipped with a very limited number of beds, intended hospitals and the same National Health Service was to manage only extremely critical situations, regarded somewhat mystifying, because it tended to reattribute as coordinated and integrated with territorial Psychi- psychiatric suffering to illness, in a naturalist and posi- atric Services and Mental Hygiene that were, however tivistic sense, negating the work accomplished to give only generically indicated. Competence for the organi- it a social dimension, both in an anthropological and zation of the entire sector, which up to then had come sociogenetic sense. under the auspices of the Provinces, on the basis of This has been expertly documented in Conversa- the 1865 Law, made just after the Unification of Italy, tions concerning the Law 180, that Basaglia published in was assigned to the Regions. The final articles refer, as 1980 not long before his death (5). mentioned, to the repeal of the 1904 Law, some articles The 180, however, although giving only very lim- of the Penal and Civil Code and the law on active and ited indications on psychiatric reorganization, brought passive voting rights, indications on a transitory phase to an end not only a period of certain treatment meth- for patients in psychiatric hospitals and on the exper- ods for persons with serious psychic disturbances but, tise of the psychiatrists and their various qualifications. compared to the 1904 Law, it completely modified the Apart from considerations on the law itself, approach and herewith lies its revolutionary character. speaking about the 180 forty years after its enactment In fact, the 1904 Law, for involuntary commit- signifies above all talking about how the change in ment, dealt primarily with the social problem of “dan- psychiatry has taken place and what psychiatry is like gerous to oneself and others” and “public scandal”. today, not only its organisation, that is affected by sev- Hospitalization, temporary for the first thirty days, for eral regional legislations, but also its skills, its doctrinal the purpose of checking the mental disturbances, cause references, its clinical expressions and ways of working. of behavioural disorders and their persistence, and the It signifies speaking about those persistent criticisms “definitive commitment” were not the responsibility and precariousness and how, in recent years, society of the patient’s psychiatrist but of a judge who gave has changed, in its culture, symbolic expressions, its authorization with a sentence issued in the Council reference values and how this has effected not only the 1978-2018. The Basaglia Law forty years after 135 behaviour of persons but also the ways of expressing 833/1978, the Lombardy region under the 1997 re- their conditions of malaise. gional law 31/1997 introduced, as previously men- As far as the organisation of Psychiatric Services tioned, profound changes in the operational proce- is concerned my point of reference is the Lombardy dures of the entire health sector. These separated the region and in particular the province of Varese. programming and control, assigned to new institu- It is, in a general sense, still that which was de- tions, the ASL (Local Health Authorities) with a wider fined in the Eighties and Nineties and, as far as resi- territorial responsibility compared to the USSL, often dential structures are concerned in the following dec- coinciding with the provinces, from those providing ade too, with some important modifications due to the specialist services, in which also included were those reorganization of the Regional Health Services which provided by the UOP, which came under the respon- came into effect with the 1997 Law 31 and from the sibility of the general hospitals (AO: Azienda Ospe- norms and guidelines of the long term regional plan- daliera -Hospital Authority) ning that specifically concerned both territorial and At the same time, the USSL were abolished, residential psychiatry. with the creation of the Departments of Mental Health Monocentrism, represented by Varese’s psychiat- (DSM) including one or more UOP and relationships ric hospital where territorial services had been adopted between the ASL-DSM and DSM-UOP were de- almost immediately after its opening in 1939, as the fined. last of the psychiatric hospitals to be built in Italy, and The DSM is the organism that includes all the considerably increased under the direction of Edoardo structures in any given territory and their job is to take Balduzzi and later under Carlo Romerio, was, from charge, in terms of coordination and planning, of the 1981, taken over by the UOP (Psychiatric Opera- care, assistance and safeguarding of mental health.
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