The Man Who Closed the Asylums

Franco Basaglia and the Revolution in Mental Health Care

John Foot

• Publisher: Verso
• Year: 2015
• Print ISBN: 9781784784164
• eBook ISBN: 9781781689271
• Topic: Politics & International Relations
• Subtopic: Italian History
• Index: Politics & International Relations

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 twentiethcentury 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.

PART I

GORIZIA, 1961–68

ONE

Gorizia: A Revolution at the Edge of Europe

‘It was a revolution. A class revolution. The most important to take place in Italy. It gave people back their souls, their faces, even their clothes – and they had been deprived of everything.’

Enzo Quai¹

‘People asked me: “What do you want to change? It’s not possible.” But, day by day, things changed. Then they asked me. “Where are you going with this?” and I said, “I don’t know.” And it was true. I didn’t know.’

Franco Basaglia²

A photo from Gorizia in 1965 captures the situation inside the psychiatric hospital in the city before journalists and photographers arrived to spread the word. The caption reads ‘Self-portrait: 1965. Ward B.’ There are forty or so men in shot, some standing, some sitting. They look a bit like a football team or a school class inexplicably comprised entirely of grown-ups. Franco Basaglia can be seen in the middle of the image, in a shirt, jacket and tie. His colleague Antonio Slavich is nearby. A few nurses also seem to be present, in white coats. The rest are patients. The group is on the steps of one of the hospital’s buildings, in the sun. Few people had heard of Gorizia or Franco Basaglia in 1965, but by 1968 this would become a celebrated and exalted place, a hotbed of change, an extraordinary example of ‘an overturned institution’, somewhere that was soon ‘idealized and mythologized’.³

Beginnings: In Exile

‘I want to say to say this to Slavich: when we started all this activity within the institution, there were just the two of us here. Now there must be at least a hundred of us here … We did a series of things and those acts led to certain results.’

Franco Basaglia (1968)⁴

‘Gorizia was, like all the other Italian asylums, a concentration camp.’⁵

‘As long as we are within the system our situation will remain contradictory: the institution is managed and denied at the same time, illness is “put into brackets” and cured, therapeutic acts are refused and carried out … We are destined to inhabit the contradictions of the system, managing an institution which we deny.’

Franco Basaglia⁶

It looked like a dead-end job. A vacancy at a grim mental asylum, right on the edge of Italy, miles from anywhere: a new director was needed there. The first time that Franco Basaglia visited the place, it made him feel physically sick. He remembered the smell of ‘death, of shit’. Memories of the six months he had spent in a fascist prison in Venice in 1944, as a twenty-year-old, came flooding back. It was 1961, winter, and Gorizia seemed like the end of the earth.⁷ In many ways, it was, at least in European terms. This provincial⁸ psychiatric hospital (built under Austrian rule, in 1911, and originally named after Franz Joseph I) had the iron curtain – the border separating Italy from Yugoslavia and therefore from a different world, the Communist Bloc itself – running through its very grounds (where it was marked, at times, simply by white signs on the ground). Yugoslav guard posts overlooked the hospital. It was a peripheral place, in a forgotten, ossified city. It was the ‘most peripheral, the smallest and the most insignificant of all the Italian asylums’.⁹ Edoardo Balduzzi referred to that post as ‘an authentic form of exile’.¹⁰

Inside, behind the classic asylum architecture of high walls, gates, fences, bars and heavy closed doors, Basaglia found over 600 patients.¹¹ Two thirds of them were of Slovenian origin, and about half did not speak Italian as a first language.¹² Around 150 of these were in the hospital as part of post-war peace agreements. Basaglia referred to this group as ‘patients who could not be removed and for whom an internal solution was necessary … they had no prospects beyond the hospital walls’.¹³ The Cold War, which had so deeply affected Gorizia, was reproduced in a stark way within the asylum walls. But the history of the asylum had always been caught up in the city’s own tragic history. Inaugurated in 1916, the hospital had been completely destroyed during World War One, like most of Gorizia itself, and was subsequently rebuilt under Italian rule.

Gorizia’s manicomio (madhouse) was a dark and sinister institution, a dumping ground for the poor and the ‘deviant’, a place of exclusion. As in most Italian asylums at that time, an architecture of containment and control had developed over time, with cages for the most unruly patients and beds with holes in them through which the immobilized could defecate. Some patients were tied to their beds most of the time, and the hospital’s beautiful gardens were hardly used. Even when inmates were allowed outside, they would often be bound to trees or benches. All the wards were closed under lock and key, and the vast majority of those inside were contained against their will. They were inside because they were, in the opinion of the judiciary and the medical staff, a ‘danger to themselves and to others’. Many had been left to rot for years, inside the asylum, with no prospect of release. ‘Therapy’ was largely confined to electroshock and insulin shock treatment, and occasional work in the asylum’s kitchen gardens. The introduction of anti-psychotic drugs in the late 1950s was just beginning to have an impact by 1961.¹⁴

It was the last place where you might think about starting a revolution. But Basaglia took the job, and within eight years Gorizia was to become the most famous mental asylum in Italy, if not in Europe. It was here that a spark was lit, leading to a movement that would undermine the very basis of all such ‘total institutions’. Nobody expected this outcome in 1961, certainly not the provincial authorities that had employed him, nor Basaglia himself. Most asylum directors at the time simply managed the situation they inherited. Many were failed academics. Very few tried to implement any kind of change at all. In this, as in so many other things, Franco Basaglia was very different to the rest. The ‘revolution’ in Gorizia took place almost by chance. If Basaglia had gone somewhere else, the asylum there would probably have remained as it was.¹⁵

It was, however, a time of change. A ‘great transformation’ was taking place.¹⁶ Italy, in 1961, was in the middle of an unprecedented boom: the so-called economic miracle. After thousands of years, rural economies and cultures began to disappear almost overnight. Peasants flooded to the cities, and factories sprung up everywhere. This rush to modernity inevitably affected Italy’s outdated and static institutions, including the antiquated asylum system. As Basaglia himself put it, ‘it wasn’t by chance … that the experience of Gorizia took place at a moment of deep cultural and economic transformation, which inevitably also affected health organizations’.¹⁷

Franco Basaglia (born in Venice, 1924) had a comfortable upbringing. His father, Enrico Basaglia, managed a lucrative tax collection company. Franco grew up in the Venetian neighbourhood of San Polo. His family were loyal to the fascist state, but Basaglia soon grew into a rebel. He became involved in the anti-fascist movement in the city as a teenage student. One of his teachers at the Liceo Classico Foscarini was the legendary Agostino Zanon dal Bo, who played a ‘fundamental role in the formation of numerous anti-fascists and partisans’.¹⁸ Dal Bo helped to set up the anti-fascist Partito d’Azione (Action Party) in the Veneto in 1942. Zanon Dal Bo’s influence led to a whole group of anti-fascists emerging from the Foscarini school: ‘recruiting a large number of his students to the anti-fascist cause, who were able to make a tremendous contribution to the movement thanks to their age and their energy’.¹⁹ But perhaps there was something more to Basaglia’s rebellion, something that went beyond the role of one of his teachers. Lucio Rubini, another student of Zanon Dal Bo’s, later claimed that Basaglia ‘was always anti-fascist … he didn’t go to the fascist gatherings, he refused to … he was in opposition to it all’.²⁰

Venice was spared many of the worst excesses of the war. Above all, it was rarely bombed, unlike almost every other city in Italy (although bombs were dropped on the Porto Marghera industrial zone and on Mestre, at times into the lagoon itself and occasionally onto the city).²¹ The size and particular form of the city made armed resistance there difficult, with no natural escape route available.²² Venice was a key part of the Italian Social Republic, and the city played host to a number of cultural ministries from that government. After 8 September 1943, the Nazis were also present in Venice.

Yet despite the structural and geographical constraints in Venice, the city developed a relatively strong resistance movement. Perhaps because of the unique form and history of the city, there were also many unusual and inventive moments of protest, such as the distribution of thousands of leaflets from the Campanile in Piazza San Marco in February 1944. When the fascists climbed the stairs to the top, they found nobody there. The anti-fascists had used timed detonators. On 12 March 1945 the famous Beffa del Goldoni (the Goldoni joke or hoax) took place in the city’s Goldoni Theatre. A performance of a Pirandello play was interrupted and an anti-fascist speech was read out (by Communist partisan Cesco Chinello) to the astonished audience while armed partisans looked on.²³

Armed resistance was rare in the city until 1944. In that year a number of actions by the partisans in Venice led to bloody reprisals. On 6 July 1944 a leading fascist, Bartolomeo Astra, was shot dead by partisans. In revenge for this assassination, the fascists arrested and shot six men in the back of the head in the Cannareggio area, although one survived to tell the tale. Then, on 26 July, a resistance bomb smuggled into the building in a trunk destroyed a fascist headquarters, killing over twenty people. This dramatic event prompted the fascists to take thirteen prisoners from the Santa Maria Maggiore prison, who were quickly tried and convicted by a special court. The men were executed on the rubble of the newly bombed building. Their bodies were then taken to the San Michele cemetery island and buried in unmarked graves. The bomb was a spectacular moment but left the tiny partisan groups very exposed to the reprisals and arrests that inevitably followed.²⁴

Tensions ran high that summer. In early August 1944, the Nazis shot seven men at dawn after a German soldier had gone missing. They also carried out extensive roundups in the Castello area of the city. It later turned out that the German soldier in question had drowned, probably after one glass too many. These men became known as the ‘seven martyrs’. After the liberation, streets would be named after them and monuments dedicated to their sacrifice.²⁵

Life in the city was increasingly hard as the war wore on. Food became scarce, restaurants were requisitioned and the population was swollen by numerous refugees, reaching some 200,000. It was pitch dark at night and people were often found dead after simpl...

Table of contents

• Cover Page
• Halftitle Page
• Title Page
• Copyright Page
• Dedication
• Contents
• Acknowledgements
• Part I: Gorizia, 1961–68
• Part II: Beyond Gorizia: The Long March
• Conclusion
• Postscript
• Index