The Man Who Closed the Asylums

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John Foot has done a valuable service by translating into English his new book on Franco Basaglia and radical Italian psychiatry. The history of this movement has been unjustly neglected in Britain, partly perhaps because asylum closures in the UK were initiated by Tory politicians such as Enoch Powell.

Basaglia first achieved fame (and notoriety) as director of the Gorizia asylum in northern Italy. From 1961 to 1969 he built a “therapeutic community” which succeeded in opening up locked wards and abolishing various forms of restraint and hierarchy. Weekly general assemblies run by patients voted on every aspect of hospital operations.

Critics on his left, however, argued that such changes simply made asylums more acceptable. In the cities of Parma and Perugia, asylum populations were cut dramatically by providing good jobs and homes, or new local mental health centres. All these reforms chimed with the radical mood of the period.

By 1971, when Basaglia took over the running of Trieste’s huge asylum, he had both learned from such experiences and won mainstream political support. With its record discharge rates, the hospital rapidly became a magnet for radicals and practitioners. The subsequent law closing Italy’s asylums — with which Basaglia has always been associated — was passed virtually unnoticed in May 1978, because this coincided with the sensational murder of Italian Prime minister Aldo Moro.

Although no more asylums were built, and few new patients were admitted to those that remained; “Law 180” was a compromise and supporters had to fight to ensure its implementation over the next decades. Despite its limitations, the law was copied by the Brazilian government and influenced mental health reform across Europe.

Basaglia’s politics were often unclear. He initially denounced Law 180, then later took the credit for it. He changed his view of mental illness several times, embracing the term anti-psychiatry only to disown it when its popularity declined. Not everyone coped with being discharged from the asylums: two of his patients even committed murder. Those remaining were often reluctant to leave — their enhanced status as patients contrasted starkly with their anonymity in the outside world.

Foot discusses the furious debates in anti-psychiatry. In Italy the movement was directed either against psychiatric hospitals as a whole or against aspects of their practice. Influenced by the ideas of Mao more often than Marx, Basaglia and his followers believed willpower and the force of ideas alone could allow a minority to inspire far-reaching change.

This book is both an honest and detailed record of a neglected history and a valuable tool in the fight to defend mental health services today — both in Britain and elsewhere.