Removed in death as in life, in Venice and Trieste no street bears his name. Yet he was the protagonist of an event hitherto unheard of in the world: the closure of asylums. He taught that mental illness is also a social illness. And that responsibility and dignity are therapeutic.
When Franco Basaglia dies on August 29, 1980, at the age of only 56, Il Gazzettino di Venezia relegates the news to the news, while Il Piccolo di Trieste treats it with detachment. And yet, Basaglia is Venetian by birth and was head physician of the Trieste asylum. It is an oblivion that persists: even today, Venice and Trieste do not have a square or street named after him; there is one, however, in Rio de Janeiro, the city that hosted his famous Brazilian conferences.
Nemo a prophet in his homeland. It is the fate of irregulars who do not belong to any official church. It is no coincidence, if anything the manifestation of that rational ignorance that drives us to decide not to know: only in this way, in fact, can we consolidate our prejudices avoiding the fatigue of doubt and confrontation. Ignoring biographies like that of Franco Basaglia is not, then, just a cultural problem. It is above all a political problem, because the void (of memory) asks to be filled with something full, decanted from a present that does not offer stories of equal depth.
Already in his lifetime, Franco Basaglia was subject to removal from the academic world, in its way a total institution: “I entered the university three times and three times I was expelled”. First from the University of Padua, to go and direct the asylum in Gorizia. Then from the University of Parma, where he taught mental hygiene for eight years “during which I was isolated like a plague victim”. Finally, when, as a new full professor, he declined the chair of geriatric neuropsychiatry that was offered to him to marginalize him: “I preferred to refuse and go back to the asylum”.
His was the fate of the border man. He works in Gorizia, a city halfway between Italy and Yugoslavia. He works in asylums, whose walls separate – by convention – madness and normality. Since he’s gone, Basaglia pays for his fate with a sort of political and cultural confinement. Yet, with Franca Ongaro Basaglia, he was the protagonist of an event hitherto unheard of in the world: the closure of asylums, demonstrating that the impossible is possible.
There is a Calabrian proverb that best summarizes the work of Franco Basaglia: “Who doesn’t have, isn’t”. He effectively summarizes the two cornerstones of his actions: mental illness as (also) social illness; the therapeutic value of individual responsibility, through the restitution of the rights denied to the patient. Photos of the occupation of the Colorno asylum come to mind, covered by student banners that read: “The rich man’s son is exhausted, the poor man’s son is mad”, or “If the psychiatric hospital serves to cure mental illnesses, where are the sick rich?”. It is misery that produces horrors.
Basaglia is convinced of it. Not out of ideology. Not because he denies the biological causes of mental illness. Simply because, interested more in the patient than in the disease, he considers it in his unity of soma, psyche, civitas. He explains it himself, with a striking example: “It’s one thing if I call pellagra the disease of those who live only on polenta, it’s one thing if I call it misery […]. What, in fact, is pellagra? After the first symptoms (erythema, diarrhoea, tremors), psychic disturbances intervene which begin with hypochondriasis, depression and lead to serious confusional states with visual hallucinations, agitation and delirium: the real pellagrous dementia. Mental illness, finally, from ancient hunger, however”.
The (also) social causes of mental illness force the center of gravity of treatment to be shifted: prevention policy becomes central, capable of intervening in people’s living and working environments. In legal language it is called freedom from need, through the affirmation of the social rights recognized in the Constitution. Indeed, those who do not have (rights) are not, because those who have lost everything happen more easily to lose, in the end, even themselves.
For these reasons, according to Basaglia, treating the mentally ill means “restoring to him his entire existential possibilities”. Don’t calm him down, sedate him, tame him, but recognize his dignity and responsibilities, rights and duties. Which is impossible in a mental hospital, because there are people endowed with meaning only in a context endowed with meaning. Hence his struggle: first to transform the psychiatric hospital into a therapeutic community (in Gorizia); then for its definitive closure (in Trieste).
The most interesting aspect, in re-reading Basaglia’s experience, is the originality of his psychiatric practice. To the (Leninist) question “What to do?”, Basaglia replies: “Do!”.
According to Sartre’s teaching, he is well aware that “ideologies are freedom while they are being made, oppression when they are being made”. For this he prefers to measure himself with the reality of things, convinced that praxis is always a theory that has not yet been said. This commandment shines through, for example, in the work inside the asylum in Trieste (cf. Aa.Vv., Is freedom therapeutic?, 1983).
Departments open. Elimination of gowns and restraint. Patient work organized in cooperatives and regularly paid. Assemblies of patients and doctors, and between patients and doctors. Transformation of the psychiatric hospital area into a space open to the public for exhibitions, concerts, theatrical events, and international conferences as well. This will be a story common to many other cities. In 1969, in fact, his Gorizia team gave life to a fruitful diaspora that would export the Basaglia praxis elsewhere: Pirella settled in Arezzo, Jervis and Letizia Comba in Reggio Emilia, Schittar in Pordenone, Casagrande in Venice, Slavich in Ferrara. Framed in a long shot (cf. John Foot, La “Repubblica dei matti”, 2014), all these experiences of asylum de-institutionalization follow a common, effective, precise working method, far from that wicked anti-psychiatry of which Indro Montanelli accuses Basaglia (cf. Pier Maria Furlan, Sbatti il matto in prima pagina, 2016).
Alongside clinical work, Basaglia’s experience runs along the parallel track of political-institutional work. Basaglia is not an extra-parliamentary antagonist to the Republic of parties, with which he, if anything, forms alliances. In their diaspora, the Basaglians seek and find the support of provincial councilors “enlightened” by the shock that follows the visit to the city asylum, for which they are administratively responsible. They deserve grateful mention: in Arezzo, Bruno Benigni and Italo Galastri; in Colorno, Mario Tommasini; in Trieste, Michele Zanetti; in Ferrara, Carmen Capatti; in Perugia, Ilvano Rasimelli. They are communists, socialists, Christian Democrats, the expression of a new ruling class that faces politics after the war, with the republican constitution behind them.
The same law n. 180 will be approved, in 1978, with an almost unanimous parliamentary vote (with the exception of the Radical Party which considers it a ploy to avoid the referendum to abrogate the 1904 asylum law, already convened). With great intelligence, therefore, Basaglia has always used political power as a means, backed by a conviction: “That’s what I’ve already said a thousand times. We in our weakness, in this minority that we are, cannot win because it is power that always wins. We can at best convince. And the moment we convince, we win”. This makes him a sui generis intellectual, capable of uniting gradualism (in the method) and radicalism (in the objectives): a maximalist reformist, a concrete utopian, a revolutionary legalist. In short, Basaglia embodies an oxymoron.
The ripest fruit of the Basaglia experience will be the closure of the asylums. Originally, it was the Giolitti law (n. 36 of 1904) that disciplined the custody and care of the “insane”. This, in fact, was the nomen iuris of the internee: “mente captus” that is “taken to the mind”, and for this reason “dangerous for oneself and for others and of public scandal”. Chained twice, to mental illness and to the asylum where he is locked up and objectified according to categories corresponding to the forced care and custody departments: calm, semiagitated, agitated, filthy, paralytic, epileptic, infectious, suicidal.
Asylums are social dumps due to the class affiliation of the sick and the conditions in which they are held in captivity. When he enters the Gorizia prison in 1961, Basaglia experiences his very personal déjà-vu, perceiving the nauseating stench of death that he had already known in the prison in which, as a young anti-fascist, he had been locked up: “When I entered the first time i had that same feeling. There wasn’t the smell of shit, but there was a sort of symbolic smell of shit. I was certain that this was a completely absurd institution, which only served the psychiatrist who worked there to get his salary at the end of the month”.
The first reform intervention dates back to the law of the socialist minister Mariotti (n. 431 of 1968). Change the name to mental hospital. Clear the internees from the criminal record. Provides territorial mental health centers. Alongside the forced inmate, it introduces the figure of the voluntary inmate who can resign under his own responsibility at any time. It is a first crack that Basaglia will try to widen, propitiating the collapse of a sclerotic institution: at the time, the “crazy” internees numbered 100,000, still subjected to the practices of electroshock and restraint, despite the progress in the pharmacopoeia.
It is in this regulatory framework that the abolitionist device of law n. 180 of 1978, absorbed a few months later in the framework law on the National Health Service. Legally, a hospitalization against the will of the individual must be considered exceptional, residual, always reversible, of short duration and predetermined by law, assisted by procedural guarantees such as to discourage its abuse. For the first time, the protection of mental health is separated from the defense of public order because the mentally ill, as such, is no longer presumed dangerous to himself and to others (cf. Daniele Piccione, Il pensiero lungo. Franco Basaglia and the Constitution, 2013).
The volleys of criticism leveled at the so-called Basaglia law start from its entry into force. They come from relatives of dismissed patients, primary doctors, politicians of the right (and of the left, such as Antonello Trombadori), psychiatrists (such as Giovanni Jervis, already a Basagliano of the first hour, or Mario Tobino, who has become a famous writer). Criticisms that miss the target, aiming at a constitutionally oriented legislative option, and not at its slow, tiring, opposed implementation. Criticisms that return insidious, finding solid shores in the current government: today, “numbers in hand, that assault could materialize” (see, in Tomorrow, 6 May 2023, the Trieste conversation between Gianni Cuperlo and the Basagliano psychiatrist Peppe Dell’ Waterfall).
The biography written by Oreste Pivetta (Franco Basaglia, il Dottore dei Matti, 2012) tells it very well: Basaglia’s experience spans ’68 of which it is, at the same time, cause and effect. First Gorizia, then Trieste, demonstrated the feasibility of a paradigm shift which, from the asylum, could be extended to other still existing total institutions: family, school, university, hospital, barracks, prison. The anti-authoritarianism of the pages of Goffman, Foucault, Cooper translated into a possible acting out in which theory and practice advanced side by side.
It is the Zeitgeist, the zeitgeist that Franco Basaglia best embodies. A collective volume, anomalous and difficult to read such as the Negated Institution (1968), a story of the Gorizia experience in its making, sells like hotcakes and becomes a bestseller. In those surprising years, books were written (and read) to turn the world upside down, not like today about the world upside down. Here too we measure all the difficulty in overcoming our disappointing and regressive present.
Andrea Pugiotto is Professor of Constitutional Law, University of Ferrara
from L’Unità of 8/29/23
The photo is by Berengo Gardin