By Tobias Jones
August 19, 2015
Source: VOX
Photo Source: Unsplash,
Dangerous idealist or revolutionary hero? A nuanced look at a reforming psychiatrist
Franco Basaglia is still a household name in Italy. His name is always attached to Law 180 (“Basaglia’s law”), promulgated in 1978. It was a rushed compromise of legislation that effectively ended the era of detention and repression for the mentally ill. Basaglia knew it was imperfect, warning that “we should avoid a sense of euphoria”, but it was the culmination of a career on the medical barricades. In the words of the Italian philosopher, Norberto Bobbio, it was “the only real reform” in Italian history. Basaglia died just two years later, aged only 56.
Born into a comfortable family in Venice in 1924, Basaglia (who happens to be my wife’s great-uncle), was an instinctive anti-fascist, covering the blackboards of his university in 1944 with the slogan: “Death to the Fascists, Freedom for the People”. Then a medical student, he was arrested and spent six months in prison. He became part of a famous uprising in April 1945 when he and fellow prisoners broke out and led an insurrection across the city. His experience in prison was formative: when he became director of a mental asylum in Gorizia, near the Yugoslavian border in the early 60s, he said:
“It took me straight back to the war and the prison.” Primo Levi, too, was a big influence, as Basaglia would frequently draw comparisons between concentration camps and the asylum system. He felt that psychiatrists were closer to repressive prison guards than humane medics, and became fascinated by the so-called “anti-pyschiatrists” in Britain: RD Laing, Maxwell Jones and David Cooper. In experimental settings like the “Rumpus Room”, Villa 21, Dingleton and Kingsley Hall, they were trying not to demonise and medicalise mental illness, but to understand its existential and social elements, and to allow patients the dangerous freedom to explore, rather than repress, their crises. They wanted, in Cooper’s words, to understand whether invalids were truly ill, or had simply been invalidated.
On his first day in charge in Gorizia, Basaglia refused to sign the permits for the restraint of prisoners, and from then on his aim was to introduce democracy within the asylum. At one point there were more than 50 meetings a week. Doctors didn’t wear white coats and mingled freely with patients. A magazine was produced. Visits and outings were encouraged. Locked wards were opened, bars, shackles and strait-jackets removed.
Basaglia gathered around himself an “équipe” of like-minded pioneers. The atmosphere Foot describes is one of incredible energy and enthusiasm, with almost no time left for family or even sleep. Doctors were expected to be ever-present and available. The team was faced, inevitably, with opposition from the old guard of asylum staff and, especially, by traditionalist elements outside. But time was on Basaglia’s side: the anti-institutionalism of 1968 coincided with the publication of L’Istituzione Negata, a collective work (edited by Basaglia) that described the radicalism of the Gorizia experiment. It became an instant bestseller and, along with a successful TV documentary, made him famous.
There were, though, tragic incidents. Giovanni Miklus was released for a day in September 1968 and, that same afternoon, killed his wife with a hammer. Basaglia and one of his colleagues were accused of manslaughter, although both were eventually cleared. In February 1972, when Basaglia was director of the asylum in Trieste, a man called Giordano Savarin was released and duly murdered both his mother and father. Basaglia and another colleague were again tried for manslaughter and, again, both were cleared.
In 1977, a woman who had been turned down for treatment at Gorizia drowned her four year-old son, Paolo, in the bath. These deaths reminded everyone that psychiatrists were taking significant risks, and gave ample ammunition to those who wanted the experimentation to stop.
In Italy, the literature on Basaglia tends towards either idealisation or demonisation – he’s considered either a secular saint or a dangerous radical. John Foot gives a much more rounded, and fair, portrait of a complicated, committed man: a doctor who was a heavy smoker, a man who distrusted power but knew how to work with it, someone whose jacket pockets were full of notes and numbers, who had the energy to stay up all night talking but might fall asleep mid-conversation. His office door was always open. One friend remembered that he used to answer the phone in other people’s houses. He was driven, but always, it seems, grounded.
What’s interesting is that for all the adulation, Basaglia was circumspect about what he’d achieved. He wanted not to reform the institution of the asylum, but to abolish it. He didn’t want to create a “golden cage”, but to do away with the cage altogether (something he later achieved in Trieste). He recognised that he, himself, had become an institution, and was acutely aware of the possibility of being co-opted. One of his favourite lines, borrowed from Sartre, was that “Ideologies are freedom while they are in development, oppression once they are formed.”
Foot shows very clearly that Basaglia was part of a nationwide movement, rather than a lone idealist. There were many other psychiatrists and politicians struggling to do similar things in other parts of the country – in Parma, Reggio Emilia, Perugia and Arezzo – and the interaction between the politicians and medics, between the outside and the inside of the asylums, is always intriguing. Mario Tommasini, a crusader against the horrors of the asylum in Colorno, is brilliantly portrayed. Basaglia’s wife, Franca, is shown to be an integral contributor to all the debates and books. The équipe in Gorizia is depicted not as some monolithic, united team, but as a conflicted group trying to accommodate different ideas and egos.
In many ways, the real story is what happened after Basaglia’s law was passed: how families and communities did or didn’t cope with those released patients, and how those patients themselves fared. The fates of those pioneering psychiatrists is also telling. Clancy Sigal, who with Laing helped set up Kingsley Hall and the Philadelphia Association, is quoted in a footnote observing that “many doctors and nurses” were burnt out by “too-close proximity to the fierce heat of schizophrenia”: the cost of replacing aloofness with solidarity was often extremely high. It all makes for a fascinating, nuanced narrative in which the lines between the sick and the well, between the democratic free world and a violent, repressive one, are repeatedly blurred.
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