Francois Ferrero: Inquiry of the Geneva 1980s’ Psychiatry Crisis: Forced Hospitalization, ECT and Sleep Therapy
Eugenio Aguglia’s comment
I was kindly invited by Dr. Tom Ban to comment on François Ferrero’s essay, “Inquiry of the Geneva 1980s’ Psychiatry Crisis.” I found the different comments on the topic to be very interesting and I can say that, regardless of the country in which each one of us studied and worked, we can all draw from a common wealth of experiences and memories about that time of changes, between the end of the ’60s and the beginning of the ’80s, that, starting from politics, has involved every aspect of society.
At the end of the ’60s Italy was also a scene of social turmoil. This turmoil, initiated by left-wing politics, gave life to an “antipsychiatric” movement.
What was peculiar in Italy was that the attack on the dominant psychiatry was carried out by a psychiatrist himself, Franco Basaglia, a principal exponent of the new currents of “social psychiatry.”
He was born in Venice and he graduated from medical school in Padua. Always passionate about politics, Basaglia was a militant of the left-wing party Sinistra Indipendente. In 1958 he became professor of psychiatry at the University of Padua where he soon came into conflict with the dominant academic ideology and because of this, in 1961 he decided to leave his teaching position to accept the directorship of the psychiatric hospital in Gorizia.
In Gorizia, Basaglia came into contact with the sad and degrading reality of the asylum and started to put into practice his innovative ideas. He claimed that the relationship between the psychiatrist and the patient had to be “horizontal,” meaning that it should be based on reciprocal collaboration and dialog, rather than on strength and repression. Basaglia also banned ECT at the hospital.
But where did Basaglia’s ideas come from? His approach to mental illness was more phenomenological than biological. Basaglia was very into philosophy and particularly close to the existentialism of Jean-Paul Sartre, Binswanger and Foucault - even to Marxism - and on these ideas he based his psychiatric theories and career.
In 1961, when Basaglia arrived in Gorizia, Foucault’s History of Madness was published. In this literary work the author denies mental illness because, in his opinion, it’s just a social problem and he condemns the structure of the psychiatric hospital because he sees it only as a prison with the only purpose of excluding some people from the rest of society.
On Foucault’s wake, in 1967 Basaglia wrote L’istituzione negata (literally: the institution denied), a manifesto of his antipsychiatric ideas in which he wrote: “to begin with we have to deny everything around us: the disease, our social task, our role.”
To better understand the importance of the Zeitgeist in the Italian psychiatric scenario, we have to recall some of the social-political events that involved psychiatry in the late ‘60s and early ‘70s.
In 1968, even in Italy psychology and psychiatry had been the targets of protest by anti-authoritarian and anti-social movements that questioned the role and competency of every field. On the wave of this cultural spirit, Sartre was invited to hold a conference at Bologna University that was under student occupation; in Milan there was thorough opposition to the congress of the Italian Society of Psychiatry.
In 1969 the Italian communist party organized a conference in Rome about “psychology, psychiatry and power relations,” entrusting the “basaglians” to give the first speech, following the introduction by Enrico Berlinguer, thus giving political recognition to Franco Basaglia and his group.
In 1973 Basaglia founded a movement called “Democratic Psychiatry.”
The battles of Basaglia and his movement against the psychiatric system of the time culminated in 1977 with the closure of the psychiatric hospital in Trieste, of which Basaglia himself had meanwhile become director.
Finally, in 1978, with the approval of Law n.180, or the so-called “Basaglia law,” mental hospitals were definitively closed throughout the national territory. This law was part of the health Law n.833 with which the National Health Service was established. Thanks to this law, the obsolete and aberrant structures that were mental hospitals were replaced with psychiatric wards inside general hospitals, by territorial outpatient facilities and by therapeutic communities in which health workers and patients had equal dignity and rights.
Basaglia, however, was not fully satisfied with this law. In fact, he did not want psychiatric wards in general hospitals; he only hoped for the creation of non-medicalized facilities. The asylums, for Basaglia and his group, did not in fact only represent brutal disciplinary institutions, but they were the expression of the ideological character of psychiatry, seen as the instrument of a bourgeois need for social order and, therefore, ultimately the expression of the class struggle between those who have power and those who suffer for lack of it.
In this idea is evident the passage from phenomenology to Marxism for which, in addition to the closure of the asylums, a more radical political strategy would become necessary to invest the whole structure of the “psychiatric power.”
Law n.180, in addition to the well-recognized merits, also had limits. For example, it left it to the different areas of Italy (Regions) to develop criteria for its implementation and did not address the problem of expenses and funding, thus providing fertile ground for the development of inevitable differences which to this day still exist, and led to a serious lack of care that initially had to be sustained by the patients’ families.
Furthermore, when it came to the problem of chronicity, the law espoused the idea that it was only a derivate of institutionalization, while we know well that it is, unfortunately, often the natural consequence of the most serious cases of pathology.
Certainly Basaglia must be credited with having favored the closure of those violent and brutal places that asylums were, but what beneficial effects can have fully embraced the theses of the so-called “democratic psychiatry” in opposition to those founded on biological principles, including the denial of the existence of mental illness as such? In fact, if it is sacrosanct for patients to have their rights recognized, the first of these is to be treated and not only assisted from a social point of view, precisely because psychiatric patients have the same dignity as any other patient.
For this reason, in my opinion opposition between social and biological psychiatry is counterproductive. In fact, unlike the ‘60s and ‘70s of the last century, if the role of psychosocial factors in the evolution of psychiatric disorders is now recognized, it is also unthinkable nowadays, considering the progress in the field of neuroscience, to deny and ignore the fundamental and primary role of biological factors in the genesis of mental illness.
To strip psychiatry of its medical dignity, in order to carry out philosophical theories that serve to legitimize more political than scientific causes, would end up causing only harm to patients, who would only become a means to serve an ideology, and whose care should instead be the ultimate goal of psychiatry.
Fortunately, nowadays in Italy, thanks to the presence of hospitals, clinics and therapeutic communities on the national territory, there has been in fact an integration of the social and biological models. Starting from the Trieste experience, the model has evolved, guaranteeing an integration between the need to protect the patient and the scientific advances in the field of neuroscience, allowing the integration of rehabilitation and therapeutic pathways.
January 23, 2020