This week forty years ago, Italy became the first country in the world to legislate the closure of its asylums. The law was drafted by a psychiatrist and member of the governing Christian Democratic party, Bruno Orsini, but was known from the outset as ‘Basaglia Law’, after the leader of the movement that pushed for that radical and in some ways paradoxical reform. As historian John Foot has written:
Italy’s asylums were closed down by the people who worked inside them. In doing so, these people abolished their own jobs – forever. Nobody, today, is the director of a psychiatric hospital in Italy. The movement acted against its own self-interest – in a way that was the opposite of clientelism, patronage and nepotism. It was a negation of itself.
Every anniversary of this event offers an opportunity to reflect on the long-term effects of those reforms and on the ebbs and flows of the international struggle for deinstitutionalisation. But it is equally important to re-evaluate that movement in its historical specificity, and to discern what lessons, if any, its extraordinary success may hold.
Franco Basaglia left academia in 1961 to run the psychiatric hospital in Gorizia, a town of 40,000 near the border of what was then Yugoslavia. It wasn’t a career move: he had few alternatives to taking the job at that time. The inhuman conditions he found reminded him of his imprisonment as an antifascist during the last year of the Second World War, and he set out to change them, one by one, over the course of the nearly ten years he spent as director. His initial revulsion and the sense that an alternative must be possible were validated by a string of intellectual works published during the 1960s by the likes of RD Laing, Michel Foucault and Erving Goffman, which radically questioned dominant ideas about psychiatry, madness and the asylum. In 1968, he added a book of his own, L’istituzione negata (literally ‘the denied institution’), an unlikely bestseller that proved highly influential for the protest movement that was reaching critical mass at this time.
However, the Basaglian revolution consisted always, above all, of concrete actions. Although he and his collaborators stopped short of closing Gorizia’s asylum – an outcome that would have been simply inconceivable at this time – Basaglia’s team abolished the use of electroconvulsive therapy and of the so-called ‘mechanical constraints’ (strapping) that were standard for new arrivals; it opened the internal gates of the institution and abolished barriers between wards, including the separation between male and female patients; it introduced opportunities for the patients to work, and be adequately remunerated; most crucially, it revolutionised the therapeutic approach to each patient, foregrounding their whole personhood instead of their disease or its symptoms. The most well-known expression of this new culture were the large meetings in which doctors, nurses, orderlies and patients debated various aspects of the operation of the asylum, and in which every participant had voting rights.
In 1964 – while describing the multiple ways in which the asylum design appeared to obliterate human individuality – Basaglia had explained how the institution ‘stripped patients of their future’. In many ways, his approach can be described as a concerted effort to restore the agency of the people under his charge, therefore their sense of a meaningful and self-directed future. As such, this approach could not but tend towards the ultimate abolition of the institution itself, and the liberation of the people who lived within its walls.
I must take a slight detour. In 1996, at the age of 25, I was conscripted into the Italian mental health service. I was informed of this assignment by mail, on a Wednesday morning in early September. The next Monday morning, I was to report at a street address in Vicenza – a town 200 kms down the railway line from Milan to Venice. I didn’t know what I would find at this address, nor did I receive any training whatsoever in the job that awaited me. As a conscientious objector who asked to opt out of the still compulsory military service, I had very few rights, and the right to know what they planned to do with me, or where, wasn’t one of them.
The house in Vicenza looked like a perfectly ordinary two-storey house, with a little garden at the back. I was greeted by a tall, scruffy man in his late forties or early fifties. He looked at me for a couple of seconds, then confidently declared: ‘Ah, you must be Franz Kafka.’
The house was part of the local mental health service, and hosted a small number of adult men, mostly affected by schizophrenia, of which Giorgio – the man who greeted me – was the eldest. The house was staffed during the day by either one or two operatori (mental health workers) and I was to assist them in whatever way I could. To say that I worked there would be a slight overstatement. I spent most of my time at the house. I taught English to two of the men, Paolo and Stefano, and tried to help Paolo to find work (without much success). I helped Stefano with the gardening. I spent at least one or two hours a day in the company of Giorgio, whose main desires at this stage of his life were to smoke cigarettes and find someone who would listen to him. I ran a sort of cooking class, once I realised that it was possible to ask the hospital to send us fresh ingredients in place of the ghastly cooked food they delivered at meal times. And we went on trips, including a memorable one to my home town of Milan.
The mental health service wasn’t used to being assigned workers who lived in other cities. At night, therefore, I slept in an office at the old psychiatric hospital, which was now reduced to delivering a few day services. The facilities emptied of people by 6 pm, so I had the entire eerie place to myself. And because I received the pay of a regular soldier – five dollars a day – I lacked the means to entertain myself elsewhere.
What I experienced during those ten months were the effects of the Basaglia Law as it was implemented in the Italian north-east, where the movement had been at its strongest. Here, the old asylum had been replaced by a profoundly humane and caring network of services that placed the individual as citizen at its centre. The main aim of these services was to help their users to cultivate meaningful social relations (including, where possible, by restoring and strengthening the links with their families) and participate as fully as possible in society. I always found our neighbours to be very respectful of the members of our group, and I came to view that respect as a key component of the system as a whole.
Sometimes, we dealt with individuals in times of acute crisis. It wasn’t easy, and I would lie if I said that I wasn’t afraid. Yet during my entire time in Vicenza, I witnessed a single instance of compulsory treatment. One of the reasons why these orders are so comparatively rare is that by law in Italy they must be signed off not by doctors or – as is the case in many countries – the police, but rather by the mayor, acting as guarantor of the civil rights of the citizenry. It was, therefore, always the last and most extreme measure.
I couldn’t attempt to reconcile or even compare the stories of the patients I met with those who, a mere generation earlier, were still condemned to a lifetime of imprisonment, with little hope of release. Before the Basaglia Law, Italy was regulated by a law passed in 1904, which made it possible to commit men, women and children to institutions on the flimsiest of diagnoses, and the most doubtful of charges. A measure introduced under Fascism and not abolished until 1968 required that inmates of asylums also be given a criminal record. This included women guilty of prostitution and men guilty of homosexuality, as well as children who had been committed at the age of three or four because they suffered from a developmental disability. Anything that could be construed as ‘deviance’ could land you in an asylum, often at the behest of family members – or, conversely, as a result of the lack of family supports.
Yet the Basaglian movement understood that it was not enough to improve these conditions or lessen these injustices. Faithful to one of its most famous slogans – ‘the institution is not for changing, it’s for destroying’ – it demanded instead nothing less than full abolition, as the necessary condition for human equality.
That it was possible in such a short span of time to reach such an apparently unthinkable goal is not due only to the work of that unique coalition of patients, nurses and doctors, or to the leadership of Franco Basaglia and others. It was 1968 that created the cultural conditions in which to conceive of such a radical future among a generation of politicians that included several conservatives, but – as in the case of committee chair Tina Anselmi, a Christian Democrat and former partisan fighter – was collectively formed by anti-fascism.
By the time the law that still bears his name was passed, Franco Basaglia had already effectively closed the asylum of Trieste. It was the culmination of the second decade of his work. By now, Basaglia was something of an international celebrity, and got to spend time in New York and Brazil. The asylum of which he had become director opened its doors to the city by staging performances by stars of the theatre like Dario Fo and Franca Rame, or musicians of the calibre of Ornette Coleman. On 25 February 1973, patients and asylum workers marched through the city behind ‘Marco Cavallo’, a 4-metre tall papier-mâché horse named after an actual horse whose duties had included transporting laundry and garbage around the complex, and who was now charged with carrying the collective wishes and aspirations of the inmates.
In the meantime, the institution was actively working to make itself superfluous, fracturing into the services and the worker cooperatives that its people needed in order to be liberated from it and re-enter society as citizens, and that would form the concrete model for the law enacted on 13 May of 1978. The utopia had been realised: the asylum was now a non-place.
Franco Basaglia didn’t live to see the implementation of ‘his’ law, which took the best part of two decades. He died of a brain tumour in 1980, at the age of 56, one year into his term as director of psychiatric services for the Lazio region. Among those who survived him is Marco Cavallo, who marched in 2013 as part of another successful nationwide campaign, this time for the closure of Italy’s criminal asylums – the very last vestige of the old system which sought to incarcerate the mentally ill.
Basaglia’s revolution – like all good revolutions – is incomplete. The implementation of the law varies greatly from region to region, and the Italian mental health services as a whole are funded at lower levels than other European countries. The reality I experienced in Vicenza was perhaps more exception than norm. But even there, I was reminded every day of the limits that were imposed on the freedom of our ‘patients’ – the limits set by a society that is structurally unable to give them the place they deserve. For that liberation to be fully realised, we must continue to aspire.