Great wonder: the psychiatric revolution from the eyes of a little girl
Viola Ardone’s new novel retraces forty years of the history of psychiatry through the story of the lives of Elba, born in a mental hospital, and of Fausto Meraviglia, the Basaglia psychiatrist who frees her. An opportunity to reflect on a law still remains cutting-edge, but partly unapplied
a good law is like an umbrella that shelters everyone, not just those who are in the rain. Even those who had taken refuge under the eaves of a building and didn’t have the courage to come out into the open so as not to get wet.” World Mental Health Day is an opportunity to remember, through the words that Viola Ardone writes in her latest novel, “Grande marvel”, published by Einaudi, the revolution in psychiatry which culminated in Law 180 of 1978. The one that takes named after Franco Basaglia, it is a unique rule in the world: only in Italy has there been such a clear push to close mental asylums. Because the patient must be more important than the disease. And – again using the author’s words – “because if put in a position to do normal things, crazy people behave like sane people”. Great Wonder is a novel that covers 40 years of the history of psychiatry through the eyes of Elba, a child and then a woman born and raised in a psychiatric hospital, and of Fausto Meraviglia, the doctor who gives her freedom back.
Ardone, this book, after The Children’s Train and Olivia Denaro, ideally completes his “Twentieth Century Trilogy”. Why did he decide to end it with the topic of mental hospitals and mental health?
This trilogy ends on the threshold of 2020. For me this date represented a bit of a caesura, because then we entered the Covid-19 and post-Covid era. It seemed to me that this pandemic had led to the exacerbation of many problems and many pathologies linked to the psyche of the youngest and not only. This gave me the opportunity to reflect on a topic that probably remained dormant for some time and which I now feel with great urgency from many families, who do not always manage to have the opportunity to discuss it. Therefore I wanted to go to the origin, which is the date – symbolic but not only – of 1978, with the Basaglia Law, with which Italy became a country at the forefront in redefining the treatment of mental pathologies.
A theme of the book is that of labels: speaking of the old director of the mental hospital, Elba says that he knows everything about everyone and that he puts the label above the pain.
Elba has been confined to this mental hospital practically since she was born. She spent a few years in an orphanage to study, then she wanted to return to the psychiatric hospital because she only has her mother, who is there. She is reassured by the fact that at least there everyone knows what her pathology is. She says that knowing is also a bit of healing. The fact, however, is that in reality this girl doesn’t have any problems, she is in a mental hospital because her mother is there; she therefore tries in every way to discover what her label is, her illness, in order to aspire to a cure. For this reason she compiles a sort of “mental illness diary” in which she tries to gather together all the symptoms that she sees in others in order to understand what her madness is. And that’s what we all do, to varying degrees. We too sometimes listen to each other to understand if everything is going well, if we are healthy or if we have a neurosis, an obsession, a fragility, a weakness. In this, Elba is not very different from us.
There is also a passage in which a doctor from Basaglia, Fausto Meraviglia, has to give himself up to undergo electroshock in Elba.
It was a very painful thing to write because Meraviglia, when he arrives in the mental hospital in 1982, begins to try to change him. Because it is true that the Basaglia Law dates back to 1978, but it is also true that it took 20 years to be able to apply it and close all the remaining mental asylums. This process has relied heavily on the skill and courage of new generation psychiatrists. Meraviglia ideally totally abhors the methodology of electroshock, at least as it was practiced then, in a savage and punitive manner. His biggest defeat, probably, is having to resort to it for his favorite patient, this very young girl, when he sees her refractory to all other treatments of any kind. In order not to lose her, he finds himself in the utmost contradiction of having to apply a methodology that she is firmly fighting against.
Let’s continue talking about Wonder. In the book a contradiction is highlighted in an important way, as caring for others and fighting such an important battle risks distracting from those who are closest to us.
Meraviglia is a deliberately contradictory character. He is someone who spends all his energies for an ideal, to be realized every day with the principle of fairness and justice, saving these “crazy women” who have been entrusted to him as a doctor. But he is not a saint, he is not just a hero, he is someone who perhaps, instead, is unable to give himself to his closest loved ones. He is seen as a brilliant and generous psychiatrist by the world, but as a terrible father by his children. I liked that there was this discrepancy between public and private because it was actually like this for many men, especially of that generation, who were very busy outside the home. Perhaps too busy to even be able to take care of establishing a daily life and a true understanding with their loved ones.
Meraviglia, speaking in Elba about Basaglia and Law 180, says that the doctor is dead but the law is alive. Are we sure it really is?
This is a good question, which I put at the very basis of this novel, which I wrote to answer myself. It is alive, because it is currently still valid, but it is not always activated as it should. Also because it had to be gradually implemented through regional regulations which often did not exist, we know that the Regions in Italy are very different from each other. They have very different funds and are able to manage both “ordinary” healthcare and, even more so, what concerns the so-called “invisible illness” in a very different way. We still have very virtuous realities today, in which psychiatric diagnosis and treatment services – SPDC, inclusion, the idea of community, in which the suffering person is reintegrated, and realities in which none of this happens. Here the full weight of the situation falls violently on the families, who have neither the skills nor the means to manage it.
The 180 is still cutting edge and is a guide for other states. The problem is that some parts of it have remained unapplied.
In this regard, at a certain point one of the nurses says that Law 180 was made in a hurry and that, in essence, it is difficult to change anything.
This is true to a certain extent, because the law was made quite hastily so as not to go to the referendum, which had instead been proposed by the radicals. It is a law that even leaves Basaglia himself a little dissatisfied, as he would have wanted something more extreme. Despite this, however, the 180 is still at the forefront and is a guide for other states. The problem is more that it has remained unapplied in some parts and has been eroded a bit by time.
The same nurse also says that mental hospitals do not close, but only change their names. In what sense?
I spoke to some doctors and psychiatrists, who told me that psychiatric hospitals are being reconstituted in another form. Even if the great decisive element, that of detention, has disappeared: the mental hospital, considered as a place where people lose their freedom, from which they cannot leave because they are interned against their opinion, often in a punitive manner. However, there are still places that risk becoming “parking lots”, as psychiatric hospitals once were. Above all, again, there are different treatments depending on wealth and social class: poverty rhymes with madness. People who can afford treatment, who can afford to be followed even privately by a psychiatrist, an analyst or a therapist have a greater chance of feeling better and returning to normal life. Those who do not have great economic possibilities are more likely to end up in a marginal situation, living on the streets or ending up in shelters without much possibility of getting out.
One of the themes dealt with in the book is also that of women who ended up in a mental hospital only because they were inconvenient for their husband or for some other man.
What concerns women is, as usually happens, a sadder chapter. They were locked up by whoever had the authority, who was a man, the father, the husband, the brother. When there was no divorce yet, someone said that the mental hospital could be a quite practical solution for a marriage in which the wife was no longer wanted. I have read archive materials that have been studied, in which the diagnoses of women locked up in psychiatric hospitals include the words “talkative”, “erotic”, “lacks moral sense”, “unworthy mother”. They are all adjectives that have nothing to do with a psychic picture: they are judgments on that woman who, because she is talkative, erotic, etc., is excluded from society.