‘I’m not signing’
- The Man Who Closed the Asylums: Franco Basaglia and the Revolution in Mental Health Care by John Foot
Verso, 404 pp, £20.00, August 2015, ISBN 978 1 78168 926 4
In Britain, the man who closed the asylums was Enoch Powell. ‘There they stand,’ he announced to two thousand delegates at the 1961 annual conference of the National Association for Mental Health (now known as Mind), ‘isolated, majestic, imperious … the asylums which our forefathers built with such immense solidity to express the notions of their day.’ But the era of high-walled colonies for the mentally ill was past and ‘hospital building is not like pyramid building, the erection of memorials.’ There was no longer any plausible function for most of these vast complexes, and reform should ‘err on the side of ruthlessness’. The mental healthcare of the future would take place in general hospitals, and the number of beds would be halved, with care in the local community preferred wherever possible.
Powell spoke in stirring and martial terms of setting ‘the torch to the funeral pyre’, ‘the defences we have to storm’ and ‘their powers of resistance to our assault’, to an audience of people who had in many cases dedicated their lives to these institutions. His use of the term ‘asylum’ was striking. The 1930 Mental Treatment Act had legally replaced it with ‘mental hospital’ to signal that the Victorian model, in which inmates were ‘put away’ for life in crowded back wards, had been replaced by the treatment of mental disorders as diseases of the brain, using the latest discoveries in medical science. Accordingly, the Act had also substituted the term ‘lunatic’ with ‘patient’. Powell’s rhetoric collapsed such distinctions by presenting the mental hospital as a continuation of the asylum.
That same year, 1961, Franco Basaglia arrived in Gorizia, a grim outpost on Italy’s Balkan periphery overlooked by the watchtowers of communist Yugoslavia, where he’d been appointed director of the municipal asylum. Here the term – manicomio in Italian – was less controversial. Italy had had no equivalent of the 1930 Mental Treatment Act, and the legislation of 1904 that governed such institutions in Italy conceived them more as prisons than hospitals. Their primary purpose was to protect the public from the threat presented by the ‘mad’, a category that could still include epileptics, alcoholics and people with Down’s syndrome. Inmates’ civil rights were removed and medical treatment – primarily electroshock, though antipsychotic drugs were on their way in – was punishment as much as therapy, employed, along with restraints and cages, to maintain order.
The 1904 law concentrated power in the hands of the director, who had full authority over the asylum’s internal policies. At the end of Basaglia’s first day, when the head nurse passed him the list of inmates to be tied up that night, he said simply: ‘I’m not signing.’ The moment has acquired mythic status, joining other famous refusals in the history of psychiatry: Philippe Pinel striking the chains from the mad at Bicêtre asylum in 1793 (a much celebrated event that never actually took place), or John Conolly abolishing the use of restraints on his arrival at Hanwell asylum in London in 1839. As John Foot stresses throughout his exemplary account, myth and reality aren’t easily separated in Basaglia’s story. The early stages especially involved a small team of psychiatrists in a forgotten provincial hospital with few independent witnesses, and the story we have is ‘circular, limited, insular and top-down’. As Basaglia’s work became the core of a movement that spread across Italy and beyond, the story was polished into legend through its retelling in countless magazines, books, television documentaries and films. Basaglia’s refusal elegantly encapsulated the principles of the movement that took his name. The asylum was to be ‘negated’, its legitimacy rejected, and this was to be accomplished from inside the system.
Basaglia’s roots were in Venice, his background bourgeois, his sympathies anti-fascist. As a young man in December 1944 he was arrested and held in harsh prison conditions by the occupying Nazis until their expulsion from the city the following April. He studied medicine in Padua, where he specialised in mental and nervous diseases but read widely in existentialism and phenomenology: Sartre, Husserl, Heidegger, Merleau-Ponty. Few in those days entered psychiatry as a vocation but after 12 years in Padua, Basaglia was tired of university politics and the post at Gorizia offered a way out. As soon as he entered the asylum, he wrote, ‘it took me straight back to the war and the prison.’ It had ‘a terrible smell, the smell of death’. Basaglia looked for evidence of the medical efficacy of the regime, but found none: the institution was apparently run only for the benefit of those who worked there. ‘In the face of this absurd, disgraceful logic of the asylum – we said “no”.’ Together with his wife, Franca Ongaro, who assumed a little acknowledged but crucial role in the movement as a writer and translator, Basaglia assembled a team of collaborators whose views were shaped by an evolving canon that included Primo Levi’s If This Is a Man, Michel Foucault’s Madness and Civilisation, Frantz Fanon’s The Wretched of the Earth and, most significant of all, the work of Erving Goffman, which Ongaro translated for an Italian edition.
In 1961, too, Goffman published Asylums, the fruit of his research at St Elizabeth’s Hospital in Washington DC, a vast mental institution with more than seven thousand patients. His study of ‘inmate culture’ and ‘the inmate world’ drew parallels with prisons, conscript armies and concentration camps. Inmates became, in Goffman’s enduring coinage, ‘institutionalised’: they conformed to the system, avoided attention, and in the process lost their life-skills and ultimately their identities. The asylum was supposed to be a staging post to recovery and a return to normal life but in reality it was the opposite.
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