from “Il manifesto” of November 2023
There is a current of medicalizing psychiatry that can’t wait to definitively get rid of the Basaglia law. In this black legislature, there is a risk that there will be no shortage of opportunities to do so and it is good to be warned. I recently happened to listen to the thoughts of a psychiatrist who is the manager of an important local health and social care company – I will not mention his name because it is a private thought, which however takes on relevance because it expresses a widespread feeling. According to this doctor, the time has come to overcome the Basaglia law, as well as to reopen the Judicial Psychiatric Hospitals – two legal devices due to the same “anti-psychiatric ideology” which ignores the scientific nature of psychiatry as a medical science. To do this, this psychiatrist proposes a referendum to repeal it, which, given the current political situation and the perception of public opinion, would certainly be successful. Long live the black wave that reopens mental hospitals!
Consistently, the psychiatrist says he is firmly convinced that a certain minority of psychiatric patients should be segregated for life in mental hospitals, as they are incurable and cannot be rehabilitated.
We need another non-ideological law, therefore. But what does “non-ideological” mean?
It means what is maximally ideological. Psychiatry is a branch of medicine, and a new law, they say, will have to be based on scientific evidence, on epidemiological data, on new psychopathology. Scientific evidence, or – as another psychiatrist commented – “the brain is an organ to be treated like all the others”. In short, psychological distress is a question of a broken brain, as was said loudly in the nineties; “mental illness” is determined by biological, organic causes, i.e. there is a linear causal relationship between damage to the central nervous system and mental illness. The psychiatry of the counter-reformation is founded on a model centered on the individualization of the human story: «a private story», as Benedetto Saraceno said, «insofar as it happens in the genes, or in the brain, or in the psyche, however it may be in a private never influenced by a context, which is instead the primary source of our intervention tools.”
But is the “broken brain” really scientific evidence? First of all, the epidemiological data invoked by the leading psychiatrist go in a completely different direction. There is an enormous amount of epidemiological studies that analyze the role of environmental factors in determining mental illnesses, from the role of the family context in the development of schizophrenia to the protective function of the socio-cultural context with respect to the evolution and outcome of schizophrenia: the variables macrosocial and cultural and economic contexts, as well as adverse social and psychological events, are all factors that interact with the individual’s neurobiological structures.
What about psychopathology? An academic like Mario Maj, certainly not a Basagliano, clearly states that “mental disorders” are not the results of determinable causes like organic diseases, but are “the product of a complex interaction of a multiplicity of factors”: research science therefore cannot find the cause of schizophrenia, but must work on “constellations of genetic and environmental factors”; and, as far as we know today, there is only a probabilistic and non-linear relationship between biological processes and schizophrenic outcome, because the psychological and cultural processes are decisive. This means decreeing the exhaustion of the ancient (Kraepelinian) model of medicalizing psychiatry, the one at the basis of the DSM, the diagnostic manuals of mental disorders, and reevaluating Jaspers’ phenomenological approach – and Basaglia, it must be remembered, was of a phenomenological approach.
This is what psychopathology based on the most advanced neurobiological research says. And this shows how thinking about returning to a medicalizing and segregative psychiatry is not only a perverse ideology, a horrendous practice of social control, but is also, against its own premises, anti-scientific.