By Joseph Collins, Staff Writer
Franco Basaglia, professor, neurosurgeon and mental healthcare reformer, was the most influential Italian psychiatrist of the 20th century. His ideas revolutionized Italy’s mental healthcare system and helped establish a new approach to caring for the mentally ill that spread throughout the world. Basaglia’s proposal to dismantle psychiatric hospitals and replace them with a wide range of community-based services led to a new era of compassionate care for the mentally ill.
As the founder of Democratic Psychiatry, a human rights movement to improve mental health law and to liberate the mentally ill from segregation in mental hospitals, Basaliga’s legacy continues to this day. According to Italian philosopher Norberto Bobbio, it was the first “real reform” in Italian healthcare history. As Infinite Fire continues to honor Mental Health Awareness Month, we take a look back at the man who changed our approach to mental health care – mostly by not being afraid to think outside the box and implementing a new, compassionate method to an old problem.
Franco Basaglia was born into a comfortable, middle-class family on March 11th, 1924 in Venice, Italy. From an early age, however, Basaglia had a clear tendency toward rebellion, and he was fearless in his opposition to the status quo. Although he grew up under the strict fascist government of Benito Mussolini, Basaglia was an outspoken opponent of the government and its leaders. While attending medical school at the University of Padova, he often criticized Mussolini and wrote messages on the blackboards of his classes, such as “Death to the Fascists, Freedom for the People.”
When authorities found out that Basaglia was behind the writings, he was thrown in Venice’s infamous Santa Maria Maggiore prison for 6 months. Nevertheless, his spirit remained unbroken. In 1945 he was part of a famous April uprising, during which he and fellow prisoners broke out and led an insurrection that spread throughout Venice. Although the Mussolini government was already falling apart by that point, Basaglia was clearly unafraid of challenging the system, regardless of the consequences. By the end of the month Basaglia was free, Mussolini was dead, and a new Italian government was being put in place.
Although he was only imprisoned for a short time, Basaglia’s experience in confinement had a profound affect on him. Later in life, it would influence his thinking on the mentally ill and their treatment as prisoners rather than patients. Eventually, he would come to feel that psychiatrists in mental institutions were tantamount to harsh prison guards, causing him to rethink our entire approach to mental illness.
After World War 2 ended, Basaglia went back to medical school at the University of Padova. Upon graduating in 1949, he trained at a local school of psychiatry, where he became familiar with the radical thinking of Erving Goffman and Michel Foucault, both critics of institutional psychiatry. These writers had a powerful influence o Basaglia, and he eventually came to believe that Italy’s psychiatric practices were deeply misguided. While psychiatry was supposed to liberate the mentally ill, Basaglia believed it was oppressing them instead. For Basaglia, the need for change was urgent, and he was determined to do something about it.
With intelligence and ambition, Basaglia rapidly advanced in his field. By 1961, at the age of 37, Basaglia was appointed Director of the Lunatic Asylum of Gorizia. When he arrived at the asylum, however, he was revolted by what he described as a system of widespread neglect and indifference. Patients were placed in isolation, screaming behind locked doors (some of them locked up for life), with many of them lying nude in their own excrement—completely unattended.
As for the patients who did receive treatment, they were worse off in some ways. “Troublesome” patients were generally subjected to physical abuse, forced restraint, and drug-induced comas. The staff’s entire approach was to strike terror in those they found to be “difficult.” No counseling or purposeful activity was ever provided. Instead, patients were treated like objects, with no acknowledgement of their names or personal identities.
In addition to the poor treatment of the patients, Basaglia was disturbed by the large number of sane people who were labelled as mentally ill, simply due to some innocent quirk in their behavior. Overall, the asylum seemed more like a concentration camp than a hospital to Basaglia. His experience at Gorizia enforced his belief that the science of psychiatry was being used to foster an oppressive and prison-like atmosphere, where the ill were to be intimidated and “treated into submission.” As he later wrote: “It took me straight back to the prison.”
CHANGING THE SYSTEM
As the asylum’s new director, Basaglia was expected to apply all the techniques of oppression that were systematically carried out and that he had learned at school. Of course, he wanted no part of that approach. He refused to bind patients to their beds and abolished any method of isolation. He was determined to bring freedom and democracy to his patients, no matter what the cost.
Influenced by Europe’s reformist thinkers and the experimental therapeutic communities in the UK at the time, Basaglia began changing the asylum from the inside out. To help bridge the divide between doctors and patients, Basaglia demanded that doctors stop wearing white coats, and he encouraged them to mingle freely with the patients. His goal was to have doctors and patients interact with compassion and mutual respect. For the patients, locked wards were opened, and shackles and straitjackets were done away with. In addition, family visits and outings were encouraged to help break down feelings of isolation and hopelessness.
Basaglia also brought in like-minded pioneers to help him reorganize the asylum’s social structure. Although the traditional doctors opposed this new approach, Basaglia was determined to change the system. His overall goal for the patients was treatment and reintegration back into society, whenever possible. Over time, Basaglia began to release patients back into the community, with great success. And for those patients who were too ill to be released, the newly reformed system helped many of them make steady progress.
Basaglia’s understanding of mental illness was quite different from prevailing attitudes of the time. Unlike most of his peers, Basaglia believed mental illness was generally caused by society’s harsh treatment of people who are different. By ostracizing those who do not fit in, he believed, society often creates or exacerbates the mental illness.
“The mental illness is not the reason and origin, but the necessary and natural consequence of the… exclusion processes potentially and concretely acting in all social institutions.”
In other words, Basaglia felt that whatever issues the patient was dealing with were compounded by the act of locking them up in mental institutions and making them powerless in determining what happens to them next. This created a sense of hopelessness, which often drove patients to true mental illness more than anything else in their lives.
Basaglia recognized that many of the characteristics of his patients that were believed to be inherent in their mental illness – the vacant stares, the repetitive gestures and movements – seemed to dissolve as the patients left the confines of the asylum. And his conclusions were that we could not truly understand what mental illness is, or what limitations they put on people struggling with it, until both staff and patients were free from the beliefs, attitudes and culture of asylums.
Basaglia felt that all asylums needed to be closed down so that they could get rid of the authoritarian power structure that existed in those institutions. Until asylums were eliminated, Basaglia felt that patients would forever feel their freedom was in the hands of doctors and that they had no say in their treatment. The only result possible would be despair and mental deterioration.
DELIVERING HIS IDEAS TO THE PUBLIC
Basaglia began issuing reports on his findings and theories. His very first, “The Destruction of the Mental Hospital as a Place of Institutionalization,” was delivered by him to the First International Congress of Social Psychiatry, held in London in 1964. In the report, Basaglia stated that, “the psychiatrist of today seems to have discovered, suddenly, that the first step towards the cure of the patient is his return to liberty, of which, until now, the psychiatrist had deprived him.”
His main points were to re-train psychiatrists and nurses to be more sensitive to the needs and comforts of the patients; to keep the patients (as much as reasonably possible) in contact with the outside world, especially family and friends; to allow them to pursue their own interests on the outside world (again, as much as reasonably possible); and the creation of an open door system in general. In 1968, Basaglia edited a collection of his written works, called “The Institution Denied.” It was widely read throughout Italy, became a global best-seller, and it made him famous.
Basaglia later went on to serve as director of another asylum from 1971 to 1979, this one in Trieste, Italy, where he applied the same methods that he had so much success with at Gorizia. Although there were a few incidents of patients committing violent acts upon release, these incidents were few and far between, and Basaglia’s approach seemed to be mostly successful.
LEGACY AND DEATH
Although Basaglia’s ideas were not initially accepted and implemented, they were gradually embraced over time. By 1978, after years of debate, a national reform bill called the Italian Health Care Act of 1978 (Law 180, or Basaglia’s Law) started the gradual but radical closure and dismantling of mental hospitals throughout the country. This bill was met with a range of public reactions: enthusiasm, criticism, hostility and confusion. But now, many years later, most countries around the globe, have been influenced by Basaglia’s model and have adopted the same or similar methods. And after almost 40 years, Law 180 remains unique in mental health law around the world, as Italy is the only country where traditional psychiatric hospitals are actually illegal.
After years of working to help those with mental illness, Franco Basaglia passed away on August 29th, in 1980, at the age of 56. Sometimes hailed as a psychiatric saint, sometimes as a “foolish ideologue,” Basaglia has nonetheless created a radically new approach to dealing with mental illness—one that encourages compassion and respect for the patient, as well as mutual participation between patients and doctors in the decision making process. Further, it is an approach that does not assume patients are “mentally ill” just because they don’t conform to society’s “norms.” Finally, it does not assume that those who are truly ill, are beyond help and healing. Basaglia’s approach is inclusive, democratic and, most importantly, sympathetic.
“Tomorrow morning,” Basaglia once said to his staff, “at visiting time, when, without any lexicon, you try to communicate with these men, you will be able to remember and recognize that, in comparison with them, you are superior in only one way: force.”
Basaglia’s basic philosophy, of course, was to do away with using force against helpless individuals, and his method can be summed up simply as one that shows genuine care and sympathy for a fellow human being that needs help and understanding. Franco Basaglia was a true crusader and revolutionary thinker for his time, and his insights paved the way for a kinder and more effective system in helping patients with mental illness.