If I was born in Trieste it is also because of Franco Basaglia.
The experience that took shape in the early seventies in that city had attracted my father. In that period many young psychiatrists, or in any case mental health workers, had seen in Basaglia’s practice the possibility of overturning a system, the asylum – mental hospital system, which was beginning to appear oppressive, illiberal, shameful in confirming and legitimizing the mechanisms of exclusion of subjects, even if mentally ill, living in common. Very often, especially now, I also wonder what caused my choice to become a psychiatrist. The “fault” is once again probably Basaglia’s.
When he died I was just eight years old. I lived the first years of my life in continuous contact with the reality of the psychiatric hospital in Trieste, where in that period we worked intensely thinking about its closure, and with the places of assistance to people suffering from mental illness. My childhood had already been “infected” by contact with them. Despite myself, I couldn’t help but recognize them as people, playmates, sometimes even rivals in competing for my father’s affection. It was always about people and I learned to experience them as such. Looking back now on those years, it is impossible not to review those events and the problems they brought with them through the filter and eyes of me as a child and which I can now understand differently.
Franco Basaglia has had to accept a difficult and stubborn confrontation with the city of Trieste several times by implementing deinstitutionalization. The concept, the prejudice of dangerousness that has always accompanied people suffering from mental illnesses was one of the most difficult obstacles to overcome. Starting from the final emotion, the fear of the presence of “crazy people” around, the meaning of restraint, of seizure of the hospital which until that moment had kept them, at least, away from sight, automatically emerges. It is inevitable for me that memories will resurface, unfortunately often blurred, which testify to the commitment made to demonstrate how unnecessary a separate space, exclusive for the “crazy”, was. It is inevitable to remember the summer parties in the enormous and wonderful park of the San Giovanni psychiatric hospital. The bonfires of San Giovanni, in fact, gave back to the city an area with all its problems, alluding to the need to take charge of the park with its inhabitants both marked by the prejudice of “madness”.
The park, built on a hill kissed by the sun according to the dictates and positivist utopias of the end of the last century, finally welcomed the city, demonstrating its beauty, showing its tenants, inviting participation. Not an impenetrable space due to the gates, which were no longer there, not a place to avoid because it was inhabited by “dangerous madmen” who instead could finally abandon their uniform and take off that label and appear welcoming and curious instead of violent and incapable of understanding. The park of the former OPP became a space of the city, thus allowing the right of citizenship to be recognized to those who, living in the asylum, were not considered worthy of it.
Even now the problem of the dangerousness attributed to people suffering from mental illnesses has not been overcome. Being “dangerous for oneself and others” is still an immediate attribute for those who manifest mental suffering of any kind. Family members, friends, colleagues are usually worried first of all by the possible social consequences of the discomfort and, even if we cannot blame them for this way of thinking, it seems necessary to make available to all the means, knowledge and information to understand how different the situation is. Unfortunately, the limits that an information-based society demonstrates in reporting on mentally ill people must be considered. Basaglia, aware of the power of communication, intelligently spent his energies also to unmask the monstrosities constructed by the intentional inertia of the media.
Even today, unfortunately, “crazy people” usually appear only when they commit crimes, preferably serious ones, and then disappear into oblivion again. Even today we continue to search for particular “characters” and “signs” of the criminal who, even if he is not a “patient”, perhaps simply escaped cataloging and therefore acted like a “madman”. The work of that time around the theme of dangerousness and the relationship of psychiatry with justice not only led to the closure of psychiatric hospitals in our country but today highlights the anachronism of Judicial Psychiatric Hospitals, which continue to fuel the imagination of dangerous, incomprehensible and incurable mental patient, effectively preventing access, even for “crazy offenders”, to normal justice paths.
Even before welcoming the city into the park of the psychiatric hospital, but the memory here is more vague and is confused with stories and photographs, it had been necessary to demonstrate the citizenship of the guests of San Giovanni. If it was not acceptable to think that the inhabitants of Trieste did not recognize the dignity of citizens of the residents of the asylum, the way to overturn this belief was to demonstrate the contradiction that the hospital walls now poorly concealed. Franco Basaglia said “It is truly a tragedy to discharge a person who was in a mental hospital. This person has spent years and years of internment and now he will have to face that reality that rejected him and pushed him into a mental hospital” and again “it’s like the division of the atom, chain reactions and contradictions are unleashed”. In Basaglia’s practice no inconsistencies are allowed, if there is a contradiction it must be unmasked, explained and overcome. The vague memories that I am lucky enough to carry with me in this case refer to events that took place, deliberately, outside the hospital. Before inviting the people of Trieste to the park, on more than one occasion we had visited them in the city, on the streets.
Giuliano Scabia, theater director and writer, had prepared “the storyteller”. As in popular tradition, events were told in this way. With a huge drawn cloth, they sang about what happened inside and outside the asylum. We sang about a frightened city, but we did it under the windows of curious citizens, forced by the evidence to admit the citizenship of the people who had joined them in their neighborhood from San Giovanni. A festive atmosphere, because celebration was the end of the oppression of the asylum, because celebration was the return to the reality of common life. In previous years it had been the moment of “Marco Cavallo”, the blue horse. This was the first, historic experience of contact with the city in Trieste. Marco Cavallo was made of papier-mâché, his belly was filled with the wishes of the guests of San Giovanni and he went around the streets in procession. Leaving the asylum, the new “Trojan horse”, he overcame the walls, the defenses and transported all the madmen and their concrete and unassailable desires into the city.
The reality of citizenship rights is different now in the practice of those who deal with the problems of people suffering from mental disorders as operators. For most of the younger colleagues, the mental hospital is not even a memory. Very few have seen the structures that held the people to whom they can offer assistance today, someone has read about the mental hospital, someone has seen photos or videos, I myself have the memory of a mental hospital with open doors. It’s probably lucky. The story of those who have seen and experienced the shamefully coherent reality of the psychiatric hospital is always anguished and distressing. It often recalls, in tone and content, the descriptions of the Nazi concentration camps, not too different in practice and based on the same principle of theft of rights and dignity. My memory of the hospital is hazy, fragmented. It seems difficult to me now to redesign what San Giovanni was with a clear understanding of its current structure and functions. The pavilions, while remaining substantially the same on the outside, have now changed profoundly and house divisions of the University, schools and healthcare company services. There are very few former psychiatric hospital patients, hosted in family homes created in some buildings. In my memory there were many more. During the endless meetings in which my father attended I wandered around the hospital park, splendid in its offer of space and nature. Alone or with friends and I saw and met. Furthermore, I attended the nursery that was immediately created inside the park for the children of operators and clients (we could then start calling them that), my memories are populated by the people who frequented the park. I believe that one of the most vivid memories is linked to Brunetta, a young girl, she was not the only one in the hospital to have undergone a lobotomy, but she often came to the kindergarten gate to offer us sweets. For years I met her in the hospital park, now unable to make her words understood, she always walked on tiptoe and, most of all, I remember the swaying of her torso as soon as she sat down. These were all effects of the surgery she had undergone. Her death was also a consequence of that operation.
Although “discharge” is a difficult moment in my clinical practice, and there is no shortage of “chain reactions”, it now concerns a person hospitalized for an absolutely limited period of time. “When a person lives in hospital, it creates incredible changes in the family. The family organizes itself in another way, regardless of the person interned.” For the generation of operators to which I belong, in almost all cases, this problem no longer manifests itself with those characteristics, although exclusion, social drift and abandonment still dramatically present themselves. It is natural today, and it is in fact our task to explain and demonstrate how much the suffering person needs to confront himself and find space in his family, in his workplace, in his neighborhood. How revolutionary it is today to think that there is no place for treatment other than the place where the person lives. Taking charge is now a gesture directly following the practice of those years, confirmed by a law that arose from that period. The critical work carried out by Basaglia towards psychiatry allows us today to address problems and look at people in a light and in a dimension unknown to psychiatry itself only thirty years ago. By rejecting the use of restraint, separation and cancellation of subjects, it is now possible to glimpse concrete paths of care, rehabilitation and emancipation in the “real world“. The current psychiatric practice, even if I think this definition would not please Basaglia, acts in the wake that he himself marked in those years. The taking charge, the respect we owe to the sick, the defense that we sometimes have to act against a society that excludes or a family that struggles to understand began then, starting from Franco Basaglia’s obsessive search for comparison with ” the real world.” Law 180, which is the direct result of the practices experimented in those years, forces us to follow other roads, other paths which, even if impervious, we must explore. Many times I found myself talking with colleagues, mostly young, who know little about the origins of their current practices, about what, experimented by Basaglia and his team in Trieste in the seventies, now allows them to act, to care beyond outside the psychiatric hospital and separations.