The Man Who Closed the Asylums: Franco Basaglia and the Revolution in Mental Health Care

by John Foot

When the wind of the 1960s blew through the world of psychiatry In 1961, when Franco Basaglia arrived outside the grim walls of the Gorizia asylum, on the Italian border with Yugoslavia, it was a place of horror, a Bedlam for the mentally sick and excluded, redolent of Basaglia’s own wartime experience inside a fascist gaol. Patients were frequently restrained for long periods, and therapy was largely a matter of electric and insulin shocks. The corridors stank, and for many of the interned the doors were locked for life. This was a concentration camp, not a hospital.Basaglia, the new Director, was expected to practise all the skills of oppression in which he had been schooled, but he would have none of this. The place had to be closed down by opening it up from the inside, bringing freedom and democracy to the patients, the nurses and the psychiatrists working in that “total institution.”Inspired by the writings of authors such as Primo Levi, R.D. Laing, Erving Goffman, Michel Foucault and Frantz Fanon, and the practices of experimental therapeutic communities in the UK, Basaglia’s seminal work as a psychiatrist and campaigner in Gorizia, Parma and Trieste fed into and substantially contributed to the national and international movement of 1968. In 1978 a law was passed (the “Basaglia law”) which sanctioned the closure of the entire Italian asylum system.The first comprehensive study of this revolutionary approach to mental health care, The Man Who Closed the Asylums is a gripping account of one of the most influential movements in twentieth-century psychiatry, which helped to transform the way we see mental illness. Basaglia’s work saved countless people from a miserable existence, and 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.

Genres: Nonfiction, History, Psychology, Mental Health, Psychiatry, Disability

433 pages, Kindle Edition

First published November 26, 2014

Reviews

[GONZA · Rating 4 out of 5]

It's nice from time to time, to read about some "good Italian" like Franco Basaglia, who was an Italian psychiatrist who radically changed the life and the institution dedicated to the "mental illness" in the seventies. I was lucky enough to meet some other people involved in this revolution because I was a student of Giovanni Jervis in Rome and later I worked for the Radical Radio (the radio of the Radical Party) so I met Marco Pannella, so I love this argument and I would like everybody to read about that and How it is possible for a man to almost completely change a part so huge like the psychiatric world.

Ogni tanto fa piacere leggere qualcosa su un italiano che ha fatto miracoli come Franco Basaglia, lo psichiatra che ha cambiato radicalmente la vita e le istituzioni dedicate alle persone con patologie mentali durante gli anni '70. Sono stata molto fortunata a mia volta, perché ho incontrato altre persone coinvolte in questa battaglia, sia perché sono stata studente di Giovanni Jervis alla Sapienza, sia perché ho lavorato con i radicali e quindi incontrato Marco Pannella e quindi questo argomento mi interessa particolarmente, anche perché dimostra come sia possibile per una sola persona cambiare una situazione immensa come quella psichiatrica.

THANKS TO NETGALLEY AND VERSO BOOK (US) FOR THE PREVIEW!

[Domhnall · Rating 5 out of 5]

When Basaglia’s academic career reached an impasse, he accepted a surprising position as director of an enclosed and oppressive asylum in Gorizia, a small, out of the way and very reactionary town, literally situated on the border between Italy and Yugoslavia at the height of the Cold War. With staff who were actively Fascist and a reactionary town council, the institution was expected to sustain its unpleasant and often violent regime without scrutiny or question. From his first day, Basaglia was determined to bring this regime to a complete halt, and his first act was to refuse to sign approval forms for patients to be tied up for the night. He had no support for this stand from staff, the profession generally, from the politicians or from the people of the town. What he achieved made him famous.

Basaglia was hugely influenced by books. “...texts Basaglia came across in the early 1960s, especially those by Erving Goffman, Frantz Fanon and Michel Foucault. Goffman’s Asylums. Essays on the Social Situations of Mental Patients and Other Inmates unpicked the perverse workings of what he dubbed ‘total institutions’, a phrase which would soon become a key part of the Basaglian lexicon. Foucault, meanwhile, provided a historical and philosophical focus on the workings of asylums and a theoretical and methodological approach to the study of madness (The History of Madness) and the containment of deviance. Both of these books first appeared in 1961, the year Basaglia took over in Gorizia...” [p30] “Laing’s classic study The Divided Self came out in 1960, although it took some years for it to become a seminal text.” [p34] “Meanwhile David Cooper, a South African–born psychiatrist, ran an open, experimental ward from 1962 to 1966 within an asylum on the outskirts of London, and later described his experiences there in another classic text, Psychiatry and Anti-psychiatry.” [p35]

Primo Levi was a constant presence in Basaglian texts from the 1960s onwards. His work was important to them. The Basaglias made sure their children read If This Is a Man at a young age. It was a key text for their understanding of the world, and the world they worked in. [p127] To Basaglia and to others, the most persuasive analogy to describe contemporary mental”asylums” was that of the concentration camp. “Asylums looked like concentration camps. They had high walls and bars, forbidding entrance-ways, long corridors, locks everywhere. They cut the hair of their inmates, took away their clothes and possessions and wedding rings, and gave them (sometimes striped) uniforms to wear. Lobotomies were routine. Inside, patients were often tortured and sometimes beaten, tied up, electrocuted, sexually abused, experimented upon, denied basic human and political rights or even killed.” [p125] In Italian asylums, the analogy with the Nazi camps was further enhanced by the reality that many of their employees and senior managers were committed Fascists, with regimes stretching back to long before the Second World War. “Of course, Franco and Franca Basaglia did not believe that the asylums were exactly the same as concentration camps or death camps. If they had done, their position of authority inside these places would have been untenable. They would have been the equivalent of concentration-camp guards. The use of Levi was symbolic, allegorical, a powerful political and literary tool, a provocation, and, at times, a crude propaganda weapon.” [p129] Nevertheless, the movement for change was brought to a head by individuals who, like Basaglia, saw what was happening within asylums as a “vision of hell” and made the decision that they could no longer be tolerated.

It was inevitable that any attempt at change would have a political dimension. Asylums were, in any case, public institutions under the control of elected authorities and regulated by a law dating back to 1908. They existed in the form they did because this served a function for at least some part of society. To secure change, the political parties and their leaders would have to be enlisted.

The big asylums were significant economically, with many people relying on them for a livelihood and for a career. Colorno’s psychiatric hospital was a city within a city, and was a vast political and economic resource for that tiny town, able to support hundreds of jobs and services (and provide votes). In fact, it was more or less the only large-scale source of employment in Colorno itself. As Tommasini said, ‘The hospital was the only source of work, the only “industry” in Colorno … the town lived off the asylum.’ [p325]

They served a local population and it was local people who made up their population. For better or worse, the lives of people within and outside the asylums were interlinked in countless important and often very personal ways. Not every patient would be at all welcomed home and some were feared or hated, but they were not non-people; they had identities. The media could and did play on fears that mad people were dangerous, relishing any incident of violence that could be blamed on such people. Conversely, there were people who would be shocked and concerned to be properly informed of the fate of people they knew who were trapped within these asylums. Mario recognized people and was recognized by people.’ They had been his comrades in arms, both during and after the war. He had fought by their side. They were his friends, and they had ended up there. He knew they weren’t mad. What was going on? How had it come to pass that ‘dozens and dozens of comrades, people who used to live in my neighbourhood and who were well known to me’ were locked up in such a terrible place? It was heartbreaking, just twenty years after the triumph of the liberation struggle of which they had been part. [p312] Tommasini had been in prison, and, like Basaglia, he saw the asylum as a scandal and its inmates as people who needed to be liberated. He used the word ‘kidnapped’ to describe what had happened to them. The people inside were prisoners who had committed no crime. [p312]

It would seem that the town of Gorizia never really adjusted to the radical changes imposed by Basiglia on their local asylum. In Parma, Basiglia influenced a mirror image of this process, in which political leadership imposed radical change against the reactionary opposition of the professionals in their asylum, establishing resources in the community – notably opportunities for paid employment and independent accommodation – which simply rendered the asylum increasingly irrelevant. In some ways, Parma became the opposite example to Gorizia. Most of the change that took place in Parma was outside of the asylum. Inside, patients were still tied up and there was a grim atmosphere of violence and oppression. [p317] In a third region, Perugia, services were transformed in a collaborative effort, with new community based services displacing the discredited asylum model. After 1965 Perugia was the setting for one of the most successful movements for the reform of mental health care in Italy, and perhaps in the world. An alliance of politicians, nurses, patients and psychiatrists managed not only to transform Perugia’s huge asylum system, but also to set up alternatives to that system across the Umbrian region. In addition, this process of rapid and radical change was accomplished with the active participation of the citizens of the city and the region. [p285]

We need to ask ourselves this question: when a psychiatric hospital closes, what is it that opens up? For while there is a celebration about closure, and the knocking down of walls, and the throwing open of doors and gates, there is silence on what is opened up.’ Brutti and Scotti [p298] These changes did indeed impose challenges on communities and families, to receive back and help care for liberated patients, and a number of tragedies did occur, with great public alarm, but it was always evident to the people responsible for closing asylums that alternative, community based services were an indispensible part of the solution. The end of the asylum was only the beginning of a revolution. For Manuali, the death of the asylum did not mean ‘the disappearance of madness, but [rather] a facing up to it’. [p305]

Indeed, Basaglia and his associates worried that excessive interest in the way asylums were transformed ran the risk of implying that reformed asylums could become the model for future provision, a solution that would misrepresent everything he stood for. He did not even see Gorizia as a model for managing change, since it was generally so experimental, tentative and gradual. He did not even accept that Gorizia was a particular success. It was an interesting experience, a learning process, not a model. everyone wants to know what to do, what can be done … and this is another way of destroying an experience. I think that today, I have become an institution … and I think that the people here today want to know things from me, and discuss specific issues, but they are asking me for something that I cannot deliver. [p456]

Basaglia and his associates moved out of Gorizia and helped to manage much more radical and rapid transformations in other (more progressive) parts of Italy. Basaglia himself went first to Parma, where he was not really needed, and then to Trieste. Much more than Gorizia, Trieste became a concrete utopia, a place where transformation could be touched, experienced, seen with your own eyes. Basaglia presided over all this with the experience of Gorizia and Parma behind him. He wasn’t interested in creating another ‘golden cage’, or a Maxwell Jones–like therapeutic community. All of that was superfluous, a waste of time. The key work would be outside of the asylum, in the city of Trieste and across the province. It was time not just to break down the walls, but to construct something entirely new, an alternative to the psychiatric hospital itself. [p414] Trieste’s hospital was not just closed down, with speed; its whole raison d’être was undermined, built as it was on separation, exclusion and silence. The period of closure was noisy and joyful, and impossible to ignore. From a total institution, built on its own rigid set of rules, violence and the idea of a closed world, the Trieste asylum was transformed into an open, creative place, where freedom and debate were more common than in the outside world, a model for change. It had become an anti-asylum. It is now something else, an ex-asylum. [p430]

If asylums served political, economic and social functions, they were also part of a wider network of established institutions serving similar requirements and evoking similar pressures both for and against change. ‘I used to think that various kinds of health institutions were necessary. The mad in the madhouse, the abandoned kids in the orphanage, the old people in the old people’s home. Basaglia taught me everything. I learned how to reject these kinds of solutions, and look for others. I began to understand the real aim of these institutions: to avoid dealing with more serious social problems. Health assistance of this kind was an alibi.’ Mario Tommasini [p316] The asylum itself was just the tip of the iceberg. Parma’s local authorities presided over a whole galaxy of institutes, ranging from orphanages to places where handicapped, deaf, dumb and blind children and others were sent, as well as decentralized asylums and a juvenile prison. Historically, Parma’s problems had been expelled to the north of its province, where they could be safely hidden away. [p310] Among other public institutions with comparable webs of influence and powerful forces both for and against social change, none were more exposed to scrutiny and conflict than the education system, from schools to universities.

For Manuali, ‘Behind every situation linked to madness, there lies a hidden plan of failed normality.’ ‘Mental illness’, he continued, ‘can be seen in the institutions who legitimate marginality’. [p299] The fact is that Basaglia was working to undermine one particular institution at a time when a whole array of factors were waking Italy up to a period of transformational change, or at any rate demands for change, which peaked in 1968 and did not subside until the Eighties. Basaglia’s initial focus and that of this book was to change psychiatry and the treatment of mental health, and in Gorizia between 1961 and 1968 he worked to this end without the backing of the politicians or the general population of that dull town. In other parts of Italy, similar transformations had different trajectories which the book describes, some with political support and an alliance of professionals with politicians, some with politicians fighting for change against reactionary psychiatrists, but ultimately the point was starkly apparent – that just as traditional institutions served the needs of their societies and their political masters, so it would ultimately be impossible to secure the desired transformations in the treatment of mental health without corresponding changes in society itself.

As Basaglia himself said in 1977: ‘The plan assumes that there is already a democratic health reform in place, a democratic culture. But in reality the people are what they are, the doctors are what they are, as are the hospitals.’ [p455]

We were looking for an alternative to psychiatry, we wanted to explore the possibilities and limits of a new way of doing things. In our society, however, a real alternative to psychiatry can only be partly realized – in a specific context and for a certain time period. Afterwards, especially if our work was effective, it became ‘dangerous’ – and then the forces of repression intervened to stop everything in its tracks, or to reintegrate and neutralize things within the system. All of this was inevitable and we knew that this was the case, but we have all learnt a great deal during this long march. [p466]

One theme throughout this book is the “dangerous” nature of Basaglia’s work and thought. During the Sixties and beyond, radical themes in psychiatry were picked up, amplified and elaborated as a central component of the immense social upheavals which peaked in 1968, not only in Italy but globally. It suggests, in fact, that the movement taught Italians how to be a ‘68er’.

However exhilarating and even inflammatory the work within the asylum of Gorizia became, the radical nature of these events seems better illustrated by the experience of Perugia. The Perugian model was clearly very different to that of Gorizia or Parma. In the former case, the asylum itself was the main focus, and the territory around the asylum was unaffected by Basaglia and his équipe. Political hostility increased this entrenchment. In Parma, the territory was used against the asylum, which resisted change. Meanwhile, in Perugia, the asylum was quickly transformed and things shifted into the cities and towns of Umbria. Gorizia introduced democracy into the asylum, but only there. Perugia could never be associated with one person or one set of ideas. The movement lived through its sense of conflict and debate – a state of permanent (if friendly) discussion. The end of the asylum was only the beginning of a revolution. [p305]

The real lesson from Perugia (but also from Reggio Emilia and later from many other areas) lay in the work carried out in pioneering decentralized mental health centres. These were known as Centres for Mental Hygiene (CIM), the rather antiquated term used in the 1968 Mariotti law. The peak of the Perugian movement in terms of the general public was marked by a series of meetings held in the 1973–74 period across the province, which ended up with the approval of a set of radical rules governing the mental health centres. These meetings were packed and addressed by politicians, psychiatrists, students (Perugia is a student town), members of the public and journalists. The rooms were always thick with the smoke of hundreds of cigarettes. Debate was fierce but carried out in a civilized and calm fashion. Nobody shouted. At the heart of all this was Manuali, whose interventions were short and went straight to the point. Accounts of the meetings were published in full, and they were recorded on tape and later studied by anthropologists. [p297]

There could be no greater contrast than this. On the one hand the surviving fascistic institutions and authoritarian political styles, intellectually oppressive and physically violent, the forcible marginalising and exclusion from society of those who are different. On the other hand, the Marxist, at times avowedly Maoist, political style, raucously inclusive, riotously anti-authoritarian, tearing down walls and barriers, and yet immensely creative, throwing out a plethora of exhilarating new opportunities for human and humane development and growth. So many readers will run from such language – to be Marxist, to be Maoist, these are not serious positions; these ideas are not within the permitted range of discourse. Would it not be dreadful and subversive to discover that Mao’s Cultural Revolution contained useful lessons for Trump’s America or Tory Britain!!

A chapter of this book puzzles over the failure to translate Basaglia’s writings into English, which a glance at Amazon’s site confirms to be the case, and it protests at length over the poverty of serious historical examination of the movement that did, in time, close all of Italy’s asylums. Indeed, sources in English assert that the movement in Italy led to chaos, which was simply not true. To be honest, the book would be more readable if it gave less prominence to its complaints. Instead of this, why not just write a decent account of this astonishing and exhilarating transformation and make sure that this time it is accurate and complete? I am sure it would be a best seller. Yet the explanation may be more obvious than it seems. Basaglia’s ideas were too dangerous then and they still are. After all, he was not trying to cure madness. He wanted to cure society and that really is revolutionary.

[Matteo Banzola]

John Foot è uno storico inglese molto attento alle vicende italiane. Ha scritto alcuni libri sullo sport, su Milano e sulla cultura italiana.

La Repubblica dei matti non è una storia della psichiatria italiana. Non è nemmeno una storia dei manicomi italiani e nemmeno una biografia di Basaglia. È una storia culturale dei decenni centrali e più fecondi della storia repubblicana, focalizzata sulle vicende della psichiatria. La centralità della figura di Basaglia è dovuta al suo ruolo svolo in quegli anni.
L’Italia è un paese capace di grandi innovazioni. In negativo, come nel caso del fascismo; ma anche in positivo, come nel caso della Resistenza (la più forte d’Europq dopo quella jugoslava), di un partito comunista capace di dar vita a “modelli” (emiliano, per esempio) studiati e ammirati perfino dagli USA, di realtà imprenditoriali di eccellenza e di prim’ordine (Olivetti, Ferrari), o di grande interesse (la moda). La chiusura dei manicomi può essere rivendicata a buon diritto come uno dei successi più belli e meritevoli della Repubblica. Il libro di Foot lo dimostra chiaramente con le descrizioni allucinanti dei manicomi e dei reparti.
Per altro, nel libro non c’è nessuna forma di sensazionalismo. La narrazione, sciolta, vivace, avvincente, è sempre equilibrata, sempre soppesata e meditata. Così come lo sono le valutazioni dei protagonisti e delle figure studiate e incontrate. Non c’è nessuna agiografia di Basaglia. Alla grande ammirazione per quello che definisce il più importante intellettuale della storia dell’Italia repubblicana, fa da bilanciamento il grande rispetto per altri protagonisti di quegli anni. Primo fra tutti, Giovanni Jervis, grande intellettuale e figura carismatica che collaborò con Basaglia a Gorizia e poi si distaccò da quella esperienza per seguire altri percorsi. E ancor di più, forse, Franca Ongaro, moglie di Basaglia. Se, come dice il proverbio, dietro a un grande uomo c’è sempre una grande donna, allora Basaglia ebbe la fortuna di avere per moglie una donna capace di stargli a fianco e, quando necessario, di guidarlo. Era lei non solo a dare forma alle vulcaniche idee del marito, ma anche a correggerle, indirizzarle, concretizzarle. Foot giustamente si rammarica la pressoché assoluta mancanza di studi sulla Ongaro.

Franco Basaglia e Franca Ongaro, in un piccolo manicomio all’estrema periferia del paese nel 1961: un posto insignificante, l’ultimo luogo a cui pensare per dar vita ad una rivoluzione. Non fu così, e non fu così per l’intrecciarsi di molti fattori.
All’ostracismo e all’esclusione che spesso le università italiane riservano ai giovani più brillanti e promettenti – motivo per cui Basaglia accettò l’incarico a Gorizia – fecero da lievito l’effervescente clima culturale che si stava formando in quegli anni: la “Storia della Follia in età classica” di Foucault, “I dannati della terra” di Fanon e “Asylum” di Goffman furono pubblicati proprio nel 1961. E a riprova della chiusura del mondo accademico, questi testi furono pubblicati grazie all’iniziativa di editori consapevoli del ritardo culturale del Paese accumulato durante il ventennio fascista come Einaudi, Rizzoli, Feltrinelli.
Clima culturale inebriante e coinvolgente dovuto al tracollo del positivismo e dell’organicismo che avevano finito i loro giorni nell’ignominia del razzismo biologico. Basaglia si immerge in questo clima, va a confrontarsi con esperienze in Scozia e a Londra, allaccia contatti con altre esperienze, si circonda di collaboratori curiosi, aperti e decisi. Sono questi stimoli che Basaglia rielabora creando la comunità terapeutica man mano che, dall’interno, smantella il manicomio.

Gorizia diventa il centro, il faro di una rivoluzione culturale che si irradia sul Paese e trabocca al di fuori. Ma è frutto, anche, di un clima innovatore non solo a livello europeo o mondiale, ma interno. L’esperimento di Gorizia trova appoggio nel Ministro della Sanità, il socialista Mariotti, altri intellettuali si mettono ad indagare la questione manicomiale: Angelo del Boca, grande giornalista e storico dà alle stampe un’opera che diventa una bomba: “manicomi come lager”. È questa l’immagine che l’opinione pubblica fa propria e contrasta.; la stessa televisione si interessa al fenomeno: Zavoli gira un documentario, fotografi di valore creano opere.
La breccia è aperta, si aprono percorsi nuovi. È questa la seconda parte del volume, dove Foot analizza alcune realtà locali. Qui, tra gli altri, a mio parere spiccano due elementi interessanti.
Il primo riguarda il fatto che il mondo politico “scopre” e si occupa attivamente del problema manicomiale. Amministrazione centrale e locale si pongono in sintonia con una parte della società civile e dell’opinione pubblica. Si intraprendono percorsi diversi, ma nel complesso le amministrazioni provinciali e locali sono attente e collaborano. Politici che non conoscevano la realtà dei manicomi, una volta scoperta ne restano sconvolti:
“Pensavo che gli istituti assistenziali fossero una necessità. Per i matti il manicomio, per i bambini abbandonati il brefotrofio, per gli anziani soli l’ospizio. Con Basaglia […] ho imparato a rifiutare queste soluzioni […] istituzioni [pensate per] accantonare i problemi sociali più scottanti” (p. 201).
Sono parole di Mario Tommasini, assessore provinciale a Parma, operaio. Qui, come altrove, l’Italia a due livelli – quello delle classi dirigenti distanti dalle classi popolari – scompare, si attivano forze dal basso. È quel che succede a Reggio Emilia, che chiama Jervis il quale crea i centri di salute mentale; è quel che succede a Perugia con Giacanelli, ad Arezzo, a Trieste, dove Basaglia avrà l’appoggio di un esponente democristiano.
Sono esperienze che conducono al secondo aspetto. E cioè ai percorsi diversi nella chiusura dei manicomi seguiti dalle singole realtà. Per chi, come me, studia la nascita dei manicomi, questo è un aspetto particolarmente interessante perché, se si guarda alla formazione delle strutture nate prima dell’unificazione, si incontrano condizioni e soluzioni diversificate a seconda delle zone, degli Stati e delle realtà locali. Nella loro dismissione e chiusura, questi retaggi sembrano ripetersi. Se è vero che ovunque i “basagliani” incontrano e ricevono sostegno politico (spesso del PCI e dei partiti di sinistra, ma non solo, come testimonia il caso di Trieste), è altrettanto vero che il movimento dal basso emerso negli anni Sessanta ed esploso a partire dal ’68 ha esercitato una pressione notevole sul ceto politico, spingendolo ad accettare o a promuovere soluzioni che altrimenti, da solo, difficilmente avrebbe realizzato. A dimostrazione di questo sta il fatto che la “legge basaglia”, come erroneamente viene chiamata la 180, è frutto di mediazioni tra operatori e politici con posizioni a volte molto distanti tra loro.

La Repubblica dei matti è un libro che si apprezza per la capacità di Foot di tenere assieme le molte sfaccettature e particolarità di queste decenni, ma soprattutto perché mantiene sempre, in tutto l’arco della narrazione un equilibrio prudente tra i vari aspetti, momenti e personalità. Si vedano, ad esempio le pagine in cui analizza e discute il concetto di “antipsichiatria”, un concetto di cui Foot rileva e mostra adeguatamente l’ambiguità: Basaglia e i basagliani non furono solo scelti come guida da molti operatori,culturali, del mestiere o attivisti che fossero, furono contrastati dall’opinione pubblica conservatrice, ma videro anche nascere posizioni alla loro “sinistra”, molto più estreme delle loro. Foot tratta questi aspetti con grande delicatezza, senza sbilanciarsi o lasciarsi andare a giudizi sommari o approssimativi (pp. 43 sgg). Oppure si vedano le pagine che ricostruiscono l’iter della legge 180 (pp. 285-294), dove si ritrova il medesimo equilibrio.
Il libro di Foot è un lavoro in cui il lettore avverte l’impegno e la fatica dell’Autore, costretto spesso ad utilizzare fonti di seconda mano per ricostruire passaggi e contesti. Ad esempio Foot segue percorso della dismissione del manicomio di Gorizia appoggiandosi a una pubblicazione interna del manicomio, “Il Picchio”, la rivista dei ricoverati. Scelta in parte obbligata perché, come spesso accade in Italia e soprattutto per enti istituzioni chiusi, parte della documentazione è andata dispersa.

Molto resta ancora da fare, da ricostruire; Foot lo ripete o lo lascia intendere spesso. Ma ci ha regalato una bussola affascinante, densa e bella davvero. Questo è un libro non dovrebbe mancare negli scaffali di chi voglia capire qualcosa di più, e da un’angolazione originale, sulla storia recente del nostro Paese.

[Laura · Rating 3 out of 5]

I will never ever finish all the books I want to read, and the reason is that I am always doing stuff like this. Why did I dedicate so much time to reading an academic book on the reforms of the Italian state mental hospital system in the 1960s and 70s. I have never heard anything about this. The subject matter is soooo specific and the author assumes you have lots of background information which makes it difficult to read. I attended liberal arts school, so I’ve had to read enough Foucault to get by, and I purposely read This Way Madness Lies for an easier supplement, but other than that I was entirely unfamiliar with the material.

Franco Basaglia ran a psychiatric hospital in Gorizia, a small town on the border with Yugoslavia. He was an antifascist in his youth and an academic, so he was coming at the position of asylum director with theoretical ideas about power rather than the way a medical doctor might approach the job. Basaglia was appalled at the conditions he found in the asylum– patients tied up in their own shit, screaming, etc. He assembled a team, including his wife, Franca, who was a very significant part of the project, and set about trying to turn the place around. This was done by giving autonomy and power to the patients. Physical markers of hierarchy between staff and patients such as uniforms or white coats were abolished. There were CONSTANT MEETINGS, where the patients could address concerns as minute as what would be planted in the garden. The purpose of these meetings was to give agency, autonomy, and identity to the patients by having a say in their day–to-day life. It reminded me of rhetoric around the empowering aspects of collective bargaining in unions.

This was all happening amidst major political events in italy (the years of lead) and also the general anti-psychiatry movement. People were getting radical and questioning whether or not mental illness even existed, or if it was just a symptom of social ills. Foucault came out with madness and civilization in 1961 and Discipline and Punish in 1975. People started thinking, hey, if we make society less fucked up, the people themselves might be less fucked up, and locking the mentally ill away isn’t helping them or society either. The team (equipe) at Gorizia collectively wrote a book called The Negated Institution in 1968. The book was a big hit and helped cement the mythology of the “Gorizian Miracle”. Journalists, academics, documentary crews etc came far and wide to see what was going on in Gorizia.

Foot’s goal with this book is to problematize the Basaglian mythology a little. Basaglia himself was acutely aware of the contradictions in his work. Thinking through these contradictions were what I found most fascinating, and this is why I do not think it was a waste of time for me to read this book. Basgalia’s goal is to abolish asylums altogether, but he himself is in charge of an asylum. He wants to dismantle the entire system not only from the inside but from the top. He’s also basically top-down encouraging a bottom-up revolution among the patients, and he seeks to destroy himself. This is like if a prison warden were a staunch prison abolitionist. It’s all well and good that the patients at Gorizia were not tied up and free to do activities and use their voice in meetings, but at the end of the day they are still imprisoned by the Institution. A golden cage is still a cage.

Many at the time were critical on this point:“He [Lucio Schittar] argued that the therapeutic community was simply a more sophisticated way of managing society and enforcing control. A therapeutic community had only one useful function for those who really wanted to change things: it could help to expose the contradictions in the system, provoking the rebellion and revolt amongst those who had been oppressed…Gorizia was seen as an example of reformism (129). Essentially, reforms make the current order more palatable, allowing it to continue. But at the same time, the conditions were SO abysmal and the patients so disenfranchised that I don’t see how conditions could have been any worse. In this case I don’t see how some accelerationist “let things be as bad as possible so people will revolt” situation would have happened, since I don’t really see how things could have been worse.

Another issue with Gorizia and other reforms was that many families did not want their loved one back, or many communities did not want a mentally ill person living in their neighborhood. I’m reading a book about sex offender housing placements to try to understand this issue a little more. There were a couple incidents that almost caused the whole project to unravel: one patient on a home release killed his wife with a hammer. This caused huge public outcry and made public opinion shift on the opening up of Gorizia. This happens with any major change: if one single thing goes wrong, suddenly the whole concept must be bunk even though the previous way of doing things was causing untold horrors and not really preventing crime anyway.

A little bit after I read this Gabbie Hanna the youtuber was having a public meltdown on TikTok. She seemed to be experiencing a manic episode and was posting 200 TikToks a day, but did not appear to be in danger of harming herself or others. All of the comments were people trying to get her committed and people were calling the police to lock her up for “her own safety”. It’s not a crime or dangerous to post 200 TikToks! I felt bleak looking through those comments after finishing this book. The fact that everyone’s first instinct is to institutionalize her, and that we truly think it’s safer and better for them. How can everyone say “free Britney” and “put Gabbie Hanna in a straight jacket'' in the same breath! We drastically need better imaginations as to what constitutes helping someone, and to rethink what situations (if ever) actually require taking away someone's autonomy.

I learned a ton from this book, and it made me think through some tough contradictions, but I did not think it was very well written. It assumes you have a ton of background knowledge, and while I’m not expecting to just jump into a totally new subject and be spoon fed all the background, there did seem to be huge gaps here. Foot will often use Italian terms and not define them. There was this section about Calates, and I eventually figured out after reading twice that he was talking about a phenomenon where people from hill towns would march into valleys in groups and demand to see their loved ones in the asylums. I learned from google translate that Calate means “drop” or descend in italian. HOW WAS I SUPPOSED TO FIGURE THAT OUT! He just carries on talking about Calates as if everyone knows both what the word means and what the phenomenon was. Maybe that’s common knowledge, but this example is illustrative of issues that pervade the book. If the subject matter itself weren’t so interesting I would have been very frustrated.

The second half of the book describes reforms/revolutions in other cities and how they compare and contrast to Gorizia. Cities had very different strategies depending on their local political environment, the personalities involved, and their willingness to be a spectacle. The last chapter covers the 1978 Basaglia law and explains why the law did not go far enough. I’ve never read anything on this topic so I can’t refute or speak to the accuracy of Foot’s analysis. The book states all the ways in which Basaglia gave patients a voice and identity, but the voices of patients and their experiences are conspicuously absent from this book. Despite the flaws in writing/execution, I found this book incredibly thought provoking, and I came away feeling hopeful.

[Martina Verdelli · Rating 4 out of 5]

Libro ben progettato e ben scritto, ricostruisce in maniera fedele ed esaustiva la battaglia rivendicata da Franco Basaglia contro la chiusura degli ospedali psichiatrici. Consiglio a chiunque volesse approfondire i propri studi in quest'ambito; ottimo come accompagnamento a ''L'istituzione negata" di F. Basaglia, per una maggiore chiarezza della storia e politica alle spalle della rivoluzione.

[Alex Delogu · Rating 4 out of 5]

An excellent history of the anti- or critical psychiatry movement in Italy from the 60's onwards. Anti-psychiatry was a contradiction, not unacknowledged, whereby the aim of psychiatry is to bring an end to psychiatry, particularly one that strips people of autonomy. The asylum situation itself played a central role as the conditions in them were likened to concentration camps with people tied up and treated horrendously. The political climate is captured well, showing the left's desire to treat all people as humans. There is one particular incident where the neo-fascist movement bombed a car, killing three officers, showing the depth of resentment towards the humane aims. Anti-psychiatry itself was by no means an unproblematic movement, many of the difficulties acknowledged here, and it would have been good to read about some of the arguments, though they are amply referenced for elsewhere. Overall an excellent history of a difficult struggle, one that continues even today.

[althietoday · Rating 2 out of 5]

Foot is a vulgar historian and this work is a flattening, crude and authoritarian account of the history of the Basaglian movement. Citing inaccessible and obtuse language, he refuses to engage with the intellectual produce of Democratic Psychiatry, leaving him to practice what is effectively a repetitive chronology centered around 2-3 banal axes of argumentation. Not a surprise that his instinctive approach to lines of demarcation within the movement is to dismiss them as having little importance, *in hindsight*. His ultimate point is hard to distinguish, and it appears that he is not sure of it either. A didactic, teacher-like liberalism provides ideological infrastructure.

Two stars come from occasional unearthing of mildly interesting quotes and occurrences.

Can be read as a negative exemplar of historiography of the radical.

[Drew · Rating 3 out of 5]

I was excited to see this book published; since Basaglia’s political projects and writings are hard to access in English. Foot does well at looking at the entire context, conflicts, and forgotten or underrepresented figures (especially women like Franca Ongaro Basaglia) that surround Basaglia, and therefor avoiding deifying a solo visionary. Nevertheless, Foot’s account assumes that the reader knows the contexts and debates surrounding Basaglia and Goriza already. The book often operates as an intervention without providing the general story first. This is disorienting, and the non-Italian reader is left piecing together the story in negative. This issue is compounded by very repetitive style that circles back on already made points often.

[Marco Innamorati · Rating 4 out of 5]

Ben scritto e ben documentato.
Forse si potrebbe discutere sulla definizione di “antipsichiatria”. Del resto è un tema complesso, visto che nessun antipsichiatra ha voluto essere etichettato come tale (a parte Cooper).
Sicuramente non è un libro agiografico verso Basaglia (come, invece, la biografia di Pivetta), anche se Foot ne avverte il fascino.
Molto chiara e opportuna la contestualizzazione storica: non è solo una lotta tra Basaglia, gli psichiatri retrivi e quelli radicali quella che porta alla legge 180, ma anche un contrasto politico tra DC, PCI, extraparlamentari di sinistra, MSI e laici.

[Michael Sullivan · Rating 5 out of 5]

A Great book! About the anti asylum movement in the 1960s. Really like how it discussed the thought leaders behind the movement which has expanded my reading list. Only negative is that while it hinted at the violence psychiatric drugs can cause (including homicidal behaviour ) If you weren't knowledgeable about the subject you would have probably missed it. This book paired with medication madness - Peter Breggin is essential reading for those interested in critical psychiatry.

[Zoe Salaun · Rating 5 out of 5]

4.5

[Mindy Greiling · Rating 3 out of 5]

Great information to prepare for a visit to Trieste's mental health system, but the book needs serious editing.

[Federico · Rating 3 out of 5]

6½

[Emma Burris · Rating 5 out of 5]

Amazing amazing book. Very inspiring. I really hope I'm able to do Fulbright in Trieste 3333 would really love to study this model...

[Erik Wirfs-Brock · Rating 3 out of 5]

Okay-ish book about a fascinating topic. The anti-psychiatry movement in some ways seems the most successful radical movements of the 1960s, as it marginalized or dissolved an institution that had existed for centuries-the mental asylum. The movement to close asylums in Italy as recounted in this book seemed especially radical, as they turned asylums into centers of radical democracy linked to the wider radical protest movement, before eventually getting a law passed to shut them down altogether. So it was good to find out and appreciate that moment where radical change was possible. Reading this from America in 2015 one can't help but feel a little ambivalent about what replaced the asylum here-basically jails, drugs and disability, and about our societies attitudes towards mental health, but it always takes a few centuries for the effects of a real revolution to be sorted out. As for the reason the book is only ok- it read like a book scavenged from academic work not meant for general audiences, with a lot of assumptions made about prior knowledge of the subject, repetitions, tangents that consist of 'mental health reform also took place in this area, but no one really wrote much about it', and references made to fascinating sounding primary sources without actually quoting them that much.