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1 October 2015

The Italian psychiatrist who ended the age of the mental asylum

As John Foot makes clear in his fascinating account of the life and times of Franco Basaglia, Italy’s “anti-institutional” movement did not deny the existence of mental illness.

By Ian Thomson

In 1961, my aunt was diagnosed with “schizophrenia in obsessional personality” and sectioned at the Hill End psychiatric hospital in St Albans, Hertfordshire – a Victorian-era institution that combined insulin-coma shock therapy with straitjackets and other forms of patient coercion. At the time, she was a student at the Royal College of Art under Professor Carel Weight, the “Alfred Hitchcock of British painting”, whose expressionist paintings transfigured the streets of London into fear-ridden landscapes of suburban apocalypse. Weight was not alone in regarding his student’s psychiatric treatment as “barbarous”. Her life was a void place, rattling with pills and pervaded by a sense of powerlessness.

Franco Basaglia, the Italian psychiatrist whose pioneering reforms led to the closure in the late 1970s and early 1980s of Italy’s manicomi (“madhouses”), apparently met my aunt in Florence, where she lived briefly before her breakdown. Shortly afterwards, in 1961, Basaglia took over an institution in Gorizia, near the Yugoslav border, and transformed it into a “therapeutic community”, where patients were fed, clothed, washed and accorded human dignity. In Italy, this was nothing short of a revolution. Power was handed over, in part, to the patients, who were no longer tied up, beaten or tortured but were encouraged to contemplate their return to “liberty”.

As John Foot makes clear in his fascinating account of the life and times of Basaglia, Italy’s “anti-institutional” movement did not deny the existence of mental illness. Instead, it aimed to make the asylum a place fit for human habitation. Prior to Basaglia’s interventions, asylums in Italy had imposed a system of punishment and control, in which the watchword was “custody” rather than “cure”. In such places, mental illness was worse than draining for the patients; it was killing.

For all his originality, Basaglia borrowed from R D Laing, Michel Foucault and other left-leaning thinkers and therapists at work in the idealistic 1960s. His Gorizian project aimed to replace the arrogant and condescending attitude (as it was often rightly perceived to be) of the old-school psychiatrist with an ever-attentive therapeutic concern. Teamwork was of the essence. The patient’s freedom was not allowed to be dependent on the doctor’s will alone.

Born in 1924 in Venice to wealthy parents, Basaglia was typical of the Italian insurrection of 1968, which was largely fought by children of the bourgeoisie. Having been jailed in Venice in 1944 for anti-fascist activity, he had a strong civic conscience and respected the right to disagree. Across Vietnam-war-era Italy, students were organising faculty sit-ins protesting against napalm attacks. At the Sorbonne in Paris, they did the same but the idea of revolution in Italy was intensified because of the nature of the ruling Christian Democrat power: corrupt, hidebound and, in Basaglia’s view, repressive.

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From the start, the Basaglian revolution was as much political as medical, Foot argues. Rashly, Basaglia was moved to equate the “asylum system” to Nazi concentration camps. Primo Levi’s Auschwitz memoir If This Is a Man, with its images of Dante-like horror and human abasement, was a major influence on the Basaglian experiment. But Levi was aggrieved by attempts to co-opt his book for the “anti-psychiatric” cause. (“You can be very badly off in the psychiatric hospital,” he said, “but there’s no oven, there’s an exit and your family can come to visit.”) Ultimately, the gauchiste image of the asylum as a punitive and alienating Nazi camp was effective only in terms of its “propagandist power” for Basaglia’s cause.

The times were changing and ­Basaglia caught the spirit of excitement in the air in 1968: the Black Panthers; the Beatles’ “White Album” and Stockhausen’s Hymnen in the record shops. That year, L’istituzione negata (“The Institution Denied”), a now classic collection of writings on “democratic psychiatry” that Basaglia edited, became a bestseller and a staple of every cultivated Italian home. A decade later, in 1978, a national reform bill known as the “Basaglia law” allowed for the gra­dual closure and dismantling of every asylum in Italy.

Over time, a network of community health clinics replaced the discredited mental health system and it became no longer acceptable to electrocute people, or to tie them to beds. While John Foot’s book is not without clichés (“seeds of change”, “drop in the ocean”, and so on), it is a superb primer on the history of democratic psychiatry in Italy and its triumph over the straitjacket of Bedlam. 

The Man Who Closed the Asylums: Franco Basaglia and the Revolution in Mental Health Care by John Foot is published by Verso (404pp, £20)

This article appears in the 23 Sep 2015 issue of the New Statesman, Revenge of the Left