‘The Man Who Closed the Asylums: Franco Basaglia and the Revolution in Mental Health Care’ reviewed by Dr Lisa Dikomitis

‘The Man Who Closed the Asylums: Franco Basaglia and the Revolution in Mental Health Care’ by John Foot (Verso, 2015).

9781781689264-max_221-0e6c6d4e08a35081e3392f91ee05c445Central to this book is an intriguing figure of Italy’s recent history, Franco Basaglia — ‘the man who closed the asylums’— and his movement that eventually led to the Italian ‘180 Law’ (the ‘Basaglia Law’) in 1978 which led to the dismantling of the Italian asylums. But it is what happens in the decade before this legal milestone was passed that makes up the substance of this beautifully written history of the ‘Basaglian revolution’.

Franco Basaglia was born in Venice, studied medicine at the University of Padua and qualified as psychiatrist in 1958. He was a charismatic and handsome character, a workaholic who co-authored seminal texts with his wife Franca Ongaro. In 1961 Basaglia became the director of the asylum in Gorizia, an isolated town on the (as it was then) Yugoslavian border. The asylum reminded Basaglia of the six months he was jailed in Venice’s prison in 1944 for anti-fascist activism. John Foot cites Basaglia’s reaction when he arrived in Gorizia’s asylum: ‘I was convinced that that institution was completely absurd, that its function was only to pay the psychiatrists who worked there. In the face of this absurd, disgraceful logic of the asylum—we said “no”’ (p. 13).

The conditions Basaglia found in Gorizia’s manicomio (madhouse) shocked him to the core: disruptive patients were locked in cages and others were tied to their beds. Some of these Beds with holes through which patients could defecate. Patients, often with shaved heads and uniforms, were stripped of their civil rights and their dignity. Once admitted to the asylum, inmates became ‘non-persons’ inside an institution where ‘[t]orture and suicide were commonplace, too normal to even cause surprise or comment’ (p. 20).

Basaglia’s anti-institutionalism and his energy to effect change was closely connected to his own autobiography, but was also inspired by the atmosphere of the 1960s and groundbreaking works by Michel Foucault and Ervin Goffman. Basaglia and his équipe (a team of like-minded clinicians and reformers) were influenced by psychiatrist Maxwell Jones and his work that converted UK asylums into open therapeutic communities. Basaglia set out to introduce democracy within Gorizia’s asylum. The material culture of the asylum changed under Basaglia: gates, locks and straight jackets were abolished. It became a place with frequent meetings and discussions between patients and staff, a place ‘where hierarchies had seemingly been dissolved and spaces for self-management created for and by the patients’ (p. 122). Patients played sports and socialised at the new bar. They went on day-trips and mixed with the locals. Their experiences were recorded in a patient-run newsletter, Il Picchio.

By 1968 Gorizia’s asylum became famous: ‘a symbol’ and ‘a place to imitate’ (p. 195). This coincided with the publication of L’istituzione negata (The Negated Institution), the central text of the movement edited by Basaglia. This had a knock-on effect and mental health care was restructured in other Italian cities too (including Reggio Emilia, Parma and Trieste). In early 1977 Basaglia announced that Trieste’s asylum would be closed down, which eventually happened in 1980, the year Basaglia died of a brain tumour. The events in Trieste led to the national ‘180 law’ ‘that called for the closure of all Italian asylums’ (p. 339, Foot’s emphasis).

John Foot has not written a conventional biography of Basaglia. His superb study rather tells the biography of this radical psychiatry movement in Italy. Basaglia is still a household name in Italy and the Basaglian movement has been the object of study of sociologists, historians, filmmakers and journalists. Key texts of the movement were rapidly available in a number of languages which explains the influence of the movement in Germany and France. The Basaglian movement is not as well-known in the English-speaking world, where it has been ‘consistently misinterpreted’ (p. 59). Many of Basaglia’s writings, including The Negated Institution, were not (or only much later) translated into English. Foot rectifies this gap with this very welcome and necessary addition to the English asylum literature. He portrays the Basaglian movement in a nuanced way, avoiding oversimplification, idealization or demonisation of Italy’s famous psychiatrist.

This book is important and its impact goes far beyond the author’s discipline — John Foot is Professor of Modern Italian History. The interdisciplinary value of Foot’s scholarship should not be underestimated and this book in particular is a gem. It bridges many disciplines: history, social sciences and the medical humanities, to name but a few. I read this wearing my ‘anthropologist’s hat’ and the fine-grained historical detail lends the book an ethnographic richness that I sometimes find lacking in works written by social scientists about (de-) and (re-) institutionalisation movements in mental health care.

Colleagues in the Arts will be particularly interested in what Foot writes about the role that documentary films and photography played at the time of the reforms in Gorizia. For instance, Sergio Zavoli’s film (I giardini di Abele) was not only aimed at psychiatrists and patients, but the public and reached ‘millions of Italians’ (p. 223). When the film was screened in early 1969 things had already changed in Gorizia, therefore capturing ‘a moment in the asylum’s history that was already part of the past’ (p. 223). I hope that this book finds its way to policy-makers too as it brilliantly illustrates how reforms in mental health care are as much politico-social as medical. I am thinking in particular about the medically-led Clinical Commissioning Groups in the UK which are responsible for their local mental health services, a challenging area in the current climate; or the mental health reforms in Belgium, to give another example, which started in 2012 with the implementation of a new law (‘Artikel 107’) and aim at delivering specialist mental health care outside the hospital walls. This book demonstrates the complexities of radical mental health reforms and how changes are made, unmade, contested and welcomed.

Foot finishes with an intimation of ‘other stories’ to be told (p. 391). I hope these stories find a home in a book like this one, because these are the kinds of books that matter.

Dr Lisa Dikomitis is Lecturer in Social Research at the University of Hull. In July 2016 she will join the School of Medicine at Keele University as Senior Lecturer in the Sociology of Health. She is the author of ‘Cyprus and Its Places of Desire: Cultures of Displacement among Greek and Turkish Cypriot Refugees’ (IB Tauris, 2012) and is currently writing a book on the dismantling of the psychiatric asylums in Flanders, based on ethnographic fieldwork in the psychiatric hospital of Menen.

Correspondence to l.dikomitis@gmail.com.

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