I am an Italian writer and contributor to Inspire the Mind, and I was born in a country known for the wrong type of political avant-garde.
We had the first fascist party in Europe and managed to switch sides in both world wars. The social reform movements that started in the 60s descended into violence in the 70s, taking the country on the brink of civil war. Twenty years later, Berlusconi invented the modern populist political style emulated in the new millennium by Donald Trump.
With so many things gone awry, it’s hard to remember that in Italy's recent past we can still find positive examples of avant-garde reform. One of these is the story of Franco Basaglia, the Venetian psychiatrist that in 1978 reformed the country’s mental health institutions, making Italy the first nation in the world to close the asylums.
Basaglia’s experience is relatively unknown and underappreciated in the United Kingdom, and this despite one of the best books recently published on the topic, John Foot’s 2015 The Man Who Closed the Asylums, was written by a British author and published by Verso in London. I am writing this piece as a complement to the recent podcast The Italian Files: Franco Basaglia, where John Foot is interviewed by writer Thea Lenarduzzi, which I curated.
But the truth is that Basaglia and his legacy aren’t very well known in Italy either. Or, to be more precise: what Basaglia wanted – and eventually managed – to achieve is often misunderstood. And his extraordinary accomplishments are, therefore, often threatened by a model of psychiatric care that in the last three decades has moved away from the humanistic roots at the core of Basaglia’s vision.
Franco Basaglia was born in Venice in 1924, and was in his forties when he came into contact with the work of R.D. Laing, the Scottish psychiatrist that would eventually become the one of central figures of the 1960s anti-psychiatry movement. Laing’s core idea was that mental suffering was (at least partially) socially constructed, and that the treatment of mental illness was a deeply political matter. Although Basaglia, like Laing, was influenced by the French political thinking on mental health, and in particular by Michel Foucault’s Madness and Civilization, he always refused the label ‘anti-psychiatry’, and distanced himself from the excesses of the movement in the 1960s, which included, for example, the use of LSD to treat schizophrenic patients.
Unlike his anti-psychiatry colleagues in the English-speaking world, Basaglia believed in psychiatry. He considered himself a man of the institutions, and wanted to reform these institutions from within. This is why he became director of the psychiatric hospital of Gorizia first (in 1962) and Trieste later (1971). And this is why, I believe, he was able to push the social reforms that eventually translated into the piece of legislation (Law 180, better known as Basaglia Law) that 45 years ago put Italy on the avant-garde of psychiatric care in the world.
When Basaglia became the director at Gorizia, in the early 1960s, mental health institutions in Italy were still “regulated by pre-fascist laws… which gave patients a criminal records despite the fact that they had committed no crime”, as John Foot writes.
Foot continues: “Inmates were subject (without any choice) to electroshock and insulin therapy, lobotomies as well as straightforward torture such as freezing water baths and a localized type of waterboarding where a cloth was placed over their mouths and water poured on top”. What the author describes here are practices that have long been abandoned, such as the electroconvulsive therapy applied without anaesthesia and muscle relaxants, or the insulin therapy, that were both (wrongly) believed at that time to help patients by inducing seizures; while freezing bath and waterboarding had been used in asylums across Europe since the 1800s.
In Madness and Civilization, Foucault had spoken of asylums as “total institutions… designed to induce conformity and control”, where “psychiatric hegemony… promotes a legitimization of oppressive roles”. Basaglia was more interested in the living conditions inside the asylums than in the theory of power, and as a practitioner he knew that doctors and nurses often worked to their best abilities to help the patients as well as they could. But his first two books, published respectively in in 1967 and 1968, had a strong Foucauldian approach, and contained “powerful descriptions of the conditions within asylums” (among the first in Italy) as well as a critique of the “class-based structures of the health system as a whole”.
In the following fifteen years, he worked relentlessly to transform the mental health institutions into something new: he started by reducing the use electroconvulsive therapy and straightjackets, both at the time wildly abused. Then he let some of the patients free to leave their rooms and, in some cases, the psychiatric hospital itself. And finally, he involved the very patients that only few years before were strapped to their beds and regularly beaten in the management of the hospital, effectively empowering them in taking care of their own recovery. It’s easy to imagine how upsetting this was in a society that still considered mental illness something incurable and to be ashamed of.
Basaglia’s experience happened at a time, the 1960s and 1970s, very fertile for social innovation. But by the time Law 180 was approved, the last working day of the Italian parliament before the Christmas break in 1978, the situation had already changed: the political climate had embittered, turning into the “years of lead”, the grim decade of the armed fight, when killings and bombings happened daily especially in the rich, industrialised cities of Northern Italy. The Basaglia Law was a great achievement, one that would inspire the reform of mental health institutions around Europe, but was also, in a sense, the swansong of a period of social and political optimism that lost much of its appeal in the more pragmatic, disenchanted decades that followed.
Basaglia’s idea of mental institution became law, and the old asylums were (or should have been) closed to leave space to the modern psychiatric hospitals and community services that we know today. But his victory was, in the words of John Foot, “a partial one… The vast majority of (Italy’s) 100.000 (psychiatric) patients re-entered normal life”, but “some… could not exist outside the asylum”. Law 180 was adopted around Italy unevenly, and in some cases the only thing that changed was the name of the institution whilst the practice of mental health care remained largely the same.
Basaglia died in 1980, aged 56, and his visionary practice died with him.
And yet, his legacy wasn’t completely lost. Although now almost forgotten, and often romanticised as a beautiful but not very realistic experiment that could only take place in a more hopeful and socially optimistic society, Basaglia’s story – and, with all the due differences, that of the anti-psychiatry movement – showed that a more radical approach to psychiatry is possible. Even more importantly, perhaps, it showed that there is a third option between accepting the ideology behind institutions and refusing them altogether, and that sometimes even the political apparatuses can change for the better.
In an age when ‘reform’ means almost invariably more privileges for the ultra-rich and worse living standards for all the rest of us, this is a lesson that should not be forgotten.