Franco Basaglia

Franco Basaglia (Italian: [ˈfraŋko baˈzaʎʎa]; 11 March 1924  – 29 August 1980) was an Italian psychiatrist, neurologist, professor, and disability advocate who was the principal proponent of Law 180, which abolished mental hospitals in Italy. The founder of the journal Democratic Psychiatry, he is considered the most influential Italian psychiatrist of the 20th century.

Franco Basaglia was born on 11 March 1924 in Venice. After obtaining a medical degree from University of Padova in 1949, he trained in the local school of psychiatry, where he acquainted himself with the philosophy of Karl Jaspers, Ludwig Binswanger and Eugène Minkowski, studied phenomenologists such as Edmund Husserl, Martin Heidegger, Maurice Merleau-Ponty, and Jean-Paul Sartre, and analyzed the work of sociological and historical critics of psychiatric institutions such as Erving Goffman and Michel Foucault.

He died in Venice in 1980.

Basaglia began working at a mental hospital in Gorizia in the early 1960s. When he arrived at Gorizia, he was revolted by what he observed as the conventional regime of institutional 'care': locked doors only partly successful in muffling the weeping and screams of the patients, many of them lying nude and powerless in their excrement. Basaglia observed the institutional response to human suffering: physical abuse, straitjackets, ice packs, bed ties, ECT and insulin-coma shock therapies to 'quiet' the melancholy and the terrified, and to strike terror in the agitated and the difficult.

Basaglia noticed that many of the characteristics of his patients which were believed to be inherent in their mental illness, such as vacant stares and repetitive gestures and movements, appeared to dissolve as the patients left the confines of the asylum. He concluded from this that society would not know what mental illnesses were, or what limitations ought to be put on persons with them, until both staff and patients were freed from the beliefs, attitudes and culture of the asylum. Basaglia insisted that much of what was traditionally understood as "madness" was actually the consequences of institutional conditions, not a real danger which the walls of a mental hospital needed to contain. He considered the psychiatric hospital an oppressive, locked and total institution in which prison-like, punitive rules are applied in order to gradually eliminate its inmates; patients, doctors and nurses are all subjected (at different levels) to the same process of institutionalisation.

Basaglia and his followers believed that psychiatry was a tool used by the establishment to provide scientific support for social control. The ensuing standards of deviance and normality brought about repressive views of discrete social groups. Basaglia was concerned that, without the complete closing of asylums, mental health professionals would unknowingly reconstitute asylum culture in community facilities. As long as confinement remained possible, professionals would continue to regard themselves as the ultimately responsible parties, and patients would continue to regard their agency and freedom as dependent on the doctor's will.

In 1961, Basaglia started refusing to bind patients to their beds and abolished isolation. His actions sparked a wide theoretical and practical debate in Italy, which resulted in the passage in 1978 of the Basaglia Law, also known as Law 180, which provided for the gradual but final closure and dismantling of the country's mental hospitals.

Basaglia's first substantial report was titled The Destruction of the Mental Hospital as a Place of Institutionalisation and was presented by him at the First International Congress of Social Psychiatry in London in 1964. In this 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 himself had deprived him" and that "it is true that the discovery of liberty is the most obvious that Psychiatry could reach." In conclusion, Basaglia tried to fix some points in an attempt to form a lever for discovering liberty:

1. Pressure on the administration on which the hospital depends, by the involved action of joint responsibility for the situation previously maintained.
2. The awakening of conscience and of joint responsibility on the part of the doctors who have accepted and preserved this situation.
3. The introduction of drugs by means of which, notwithstanding the institutionalised climate, the breaking of the "bond" of the patients was made possible.
4. The attempt at re-education—theoretical and humane—of the nurses. (This, however, is still far from having been reached.)
5. The keeping alive—as far as possible—of the ties of the patient with the world outside (family, friends, interests).
6. The opening of the doors, and the beginning of life according to the open door system.
7. The creation of presuppositions of the Day Hospital, soon to be opened, as a part-time service.

In 1968, L'istituzione negata ('The Institution Denied'), edited by Basaglia, was published. Widely read all over Italy, this book not only documented and analyzed the changes at Gorizia but also carried anti-institutional debate into other areas: factories, universities and schools.

While discussing the process of transformation of mental health care across the European Region, Matt Muijen argues that the influence of professionals has obviously been decisive, mostly psychiatrists who acted as advocates of change, such as Philippe Pinel in France in the 19th century and Franco Basaglia in Italy in the 20th. They offered conceptions of new models of effective and humane care, revolutionary for their times, replacing abusive and inadequate traditional services. Their real accomplishment was the ability to inspire politicians to advocate these conceptions and persuade colleagues to implement them, thereby enabling sustainable and real change.

Giovanna Russo and Francesco Carelli state that back in 1978 the Basaglia reform perhaps could not be fully implemented because society was unprepared for such an avant-garde and innovative concept of mental health. Thirty years later, it has become more obvious that this reform reflects a concept of modern health and social care for mental patients. The Italian example originated samples of effective and innovative service models and paved the way for deinstitutionalisation of mental patients.

Giovanni de Girolamo with coauthors argues that Basaglia's contribution was crucial to move psychiatric practice into the realm of health care and give visibility to psychiatry.

P. Fusar-Poli with coauthors argues that thanks to the Basaglia law, psychiatry in Italy began to be integrated into the general health services and was no longer sidelined to a peripheral area of medicine.

In the 2001 National Mental Health Conference, Italian neurologist and laureate of the 1986 Nobel Prize in Physiology or Medicine Rita Levi-Montalcini expressed her admiration for Franco Basaglia by calling him the founder of the new conception of mental illness, a magnificent scientist and fine human being who really lived the tragic problem of mental illness.

British clinical psychologist Richard Bentall argues that after Franco Basaglia had persuaded the Italian government to pass Law 180, which made new hospitalizations to large mental hospitals illegal, the results were controversial. In the following decade many Italian doctors complained that the prisons had become depositories for the seriously mentally ill, and that they found themselves "in a state psychiatric-therapeutic impotence when faced with the uncontrollable paranoid schizophrenic, the agitated-meddlesome maniac, or the catatonic". These complaints were seized upon psychiatrists elsewhere, eager to exhibit the foolishness of abandoning conventional ways. However, an efficient network of smaller community mental health clinics gradually developed to replace the old system.

The president of the World Phenomenology Institute Anna-Teresa Tymieniecka states that Basaglia managed to pull together substantial revolutionary and reformatory energies around his anti-institutional project and created the conditions which within a few years brought to the reform of mental health legislation in 1978. This reform was introduced amongst great enthusiasm and bitter criticism, hostility and perplexity, critical and sometimes unconditional support. Basaglia thereby managed to inflict a salutary shock on Italian psychiatry, which had previously been torpid.

American psychiatrist Loren Mosher called Basaglia the most innovative and influential European psychiatrist since Freud.

Francine Saillant and Serge Genest assert that Basaglia's reform of psychiatry in Italy, a renewed vision of Italian society, and radical critique of public institutions made him one of Italy's greatest, most progressive intellectuals and a leading figure of the second half of the 20th century.

Thomas Szasz had a radically critical opinion about the work of Basaglia. In 1986, in the preface to the book by Giorgio Antonucci 'I pregiudizi e la conoscenza critica alla psichiatria', Szasz writes the following words about the misunderstanding of the ideas of Basaglia:

Basaglia became famous for having abolished the psychiatric hospitals in Italy, statement as absurd as saying that mental diseases are diseases like all the others'. 'Basaglia, [...] never ceased to practice genuine psychiatry, fact that basically meant to reinforce, rather than to weaken, the legitimacy of the psychiatric interventions against the will of the affected persons, having transferred the place in which the commitment occurs from the psychiatric hospital to the civil hospital.