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Franco Basaglia and the Transformation of Psychiatry by: Mario Colucci and Pierangelo Di Vittorio


The present article is the preface to the French translation of Conferenze brasiliane by Franco Basaglia, published under the title Psychiatrie et démocratie (Éditions Érès, Toulouse, 2007).

Mario Colucci, psychiatrist and psychoanalyst, works for the Trieste Mental Health Department.

Pierangelo Di Vittorio,philosopher, teaches philosophy at the University of Bari. They are co-authors of the monograph.

Franco Basaglia, Edizioni Bruno Mondadori, Milano, 2001 (French translation: Franco Basaglia. Portrait d’un psychiatre intempestif, Éditions Érès, Toulouse, 2005).

 

In our view, Franco Basaglia’s conferences in Brazil in June and November,
1979 (published in Italian as Conferenze Brasiliane, 2000) provide the best
introduction to his work. The passion of his discourse, the forceful denunciation of
the miserable state of psychiatry and the intensity of the practical experiences of
change taking place at that time, all contribute to making Conferenze Brasiliane an
exceptional document. But what is perhaps most remarkable about these conferences
is Basaglia’s style, a style by which the Italian psychiatrist seems to say: ‘I have
nothing to teach’. It is this refusal of the role of ‘master’, with some sort of ideal
model to propose, and his willingness to listen and place himself in question in his
survey of Brazilian psychiatry (which appeared suspended between a situation of
terrible desolation in the present and of great hope and ambitions for the future) that
are the most striking aspects of the conferences. Italian Law 180, the first legislation
by any country to mandate the abolition of asylums, had been approved by the Italian
Parliament only one year before. But Basaglia neither invests himself with the role of
teacher nor proclaims any victory. Instead, his interventions in San Paolo, Rio de
Janeiro and Belo Horizonte were intended to open little cracks of democracy in a
country oppressed by years of military dictatorship. If Basaglia refuses the role of
teacher it is because of his belief that democracy is something that must be practised
as well as discussed. He therefore prefers to bear witness, to stand alongside his
Brazilian hosts and recount the vicissitudes of the Italian psychiatric reform, and the
struggles, doubts and enormous effort behind that reform, advising his listeners
neither to succumb to the growing disillusionment with the political process nor be
deceived by the facile illusions of technique. He encourages them to act and never
lose hope in the possibility of change. Above all, he listens and responds to questions
and the diversity of opinions being expressed, creating in dialogue rich in exchange
and debate, such as can no longer be found in similar discussions today.

How does Basaglia succeed in sustaining this style throughout the conferences?
How was he able to maintain a balance between passionate testimony and rigorous
analysis, while guaranteeing the free expression and thought of his interlocutors? A
possible explanation might be found in his charisma, personal history and political
experience. But ultimately these elements do little to explain the fascination of these
texts. In the last two years of his life, which were perhaps the most intense of his
career, and despite his steadfast refusal of this role, Basaglia had indeed become a
‘master’. It is perhaps in this involuntary role of ‘teacher’ and in his emphasis on
transformation that we find the key to these conferences, for Basaglia offers an
unexpected alternative for those who, in the late 1970’s, felt themselves trapped
between the collapse of revolutionary utopias and the regression into violence, both
in the political and in the increasingly apolitical personal sphere. And he proposes
this alternative at both the general level, with the political transformation of the
community, and at the personal level, with a profound transformation of the Self.

Generally speaking, at the time of these conferences, the death of the asylum
was an established fact. Twenty years of anti-institutional struggle had shown that the
‘impossible is possible’,1 creating a situation which it would be ‘difficult to reverse’.2
Henceforth, even if asylums continued to exist or were re-established, the psychiatric
problem could no longer be defined in terms of total institutions. This
uncompromising position sounded even more radical in a society like that of Brazil,
where asylums had swollen beyond all proportion, with thousands of persons massed
together in a state of exclusion, provoking a sense of horror and dismay.3 For
Basaglia, the problem was not the clinic or diagnostic techniques, drugs or
psychoanalysis or even our good intentions and the language of politics. The problem
was Juqueri, the logic of death,4 the asylum as supreme arbiter which decided all and
drained away even the last residues of life and vitality. In the face of this horror, an
extraordinary mobilisation was necessary, an ‘action of liberation’5 which went
beyond the walls of the asylum and called into question society as a whole, with its
logic of exclusion and its reality made up of misery and deprivation. The focus of
action had shifted and could no longer be confined to the specific field of psychiatry.
The time had come to question how society organised all of its exclusionary
procedures, and not just those for madness. While psychiatry provided a good
example of these procedures, it was hardly unique. It was a point of departure, a field
of practices and concrete actions which countered the myth of permanent revolution
and blunted the accusations of vagueness made by its detractors.

 

Basaglia’s refusal to limit himself to a direct attack against repressive
psychiatric power, denouncing the scandal of the asylum as premise and prelude to
the militant act of breaking down the asylum walls, is especially evident here. One had to go further and examine why the reasons for civil coexistence had been lost,
why solidarity was in decline, and why people were once again withdrawing into
their private shells. It was necessary to analyse the dispersion of the experiences of
struggle and the increasing difficulty in keeping them united in a common cause, and
to deal with a power which had become pervasive, which instead of repressing,
atomised and separated, dissolving social ties and denigrating collective experiences,
thereby reducing them to banalities. If the smashing of the paradigm of internment
offered a fundamental model for change, because ‘we now know what can be done’,6
it was equally imperative to realise that such action could not be confined to the area
of psychiatry. If ‘we now know what can be done’ this was because a different
approach had been tried, personal needs had been given priority over institutional
needs, asylums had been shut down. We now know what is possible, Basaglia tells
his listeners, and that this experience is valuable and useful not only for psychiatry
but for society as a whole. ‘In order to convince the general population we had to first
bring the mentally ill person into the street, into social life. By doing so we stimulated
the city’s aggressiveness against us. We had to create a situation of tension in order
to make visible the change that was taking place. After a certain period of time, the
city understood what was happening’.7 The work of transformation had thus already
gone beyond the specific realm of psychiatry; it had entered into the community, the
general population, in a steady crescendo of tensions. Not to win, but to convince was
the guiding principle here. Between consensus and conflict, the city had been forced
to confront the contradictions between health and illness, freedom and social control,
and then respond to these contradictions. The real meaning of the anti-institutional
experience for Basaglia was in ‘the political transformation of the community’.8 And
this transformation only became possible when a problem which concerned everyone
was removed from the technical context which had sequestered it, and from that
absolute minority of technicians whose responsibility it was. When this ‘desequestration’
occurs ‘The psychiatric or non-psychiatric problem emerges and is
freed of psychiatric complicity and collusion. It becomes something that belongs to
society as a whole in a very real way, so that people can then judge for themselves
how the institution performs, and whether the institution functions properly or not’.9

Those who had followed Basaglia’s anti-institutional struggle and the
development of his thought recognised a continuity between the approach which
finally triumphed in Trieste, and the previous experiences in Gorizia and Parma. This
approach consisted of an intense activity within the community, whether the
therapeutic community within the asylum or the enlarged community of the city and,
most importantly, an intense engagement with violence. It was an effort which
sought to recover and redeem rather than repress. In Gorizia, Basaglia soon realised
that the most difficult inmates, those who had not only resisted asylum discipline but
who were also hostile to the new openness of the therapeutic community, were the
only resource available for revitalising the ‘dead zone’ of a psychiatric hospital. It
was not a question of controlling their aggression or suppressing their opposition, but
of harnessing these elements as forces for change, while also recognising in that
resistance a constant reminder of the abyss of power that, in any case, continued to
exist between the healthy person and one who is ill. Basaglia and his group were well
aware of the risk of a latent authority that re-surfaced to exercise a vertical discipline
when a patient pretended too much freedom or caused too great a disturbance. But
they were also aware of the opposite risk, that of a benign paternalism used to induce
patients into a repetitive and oppressive disciplinary world.10 Space and voice had to
be given to those patients who did not adapt and were still able to maintain a ‘peer to
peer relationship’, who continued to manifest a healthy dose of aggression that
precluded any feelings of recognition or attachment towards the person providing
care.11

For Basaglia, restoring the right to mental health, initially within the
therapeutic community and then outside the asylum, in the polis, meant restoring the
right to express dissent and question roles of power. Only through dissent and a
questioning of power was it possible to construct a knowledge alternative to the
dominant ‘master’s’ discourse of psychiatry, and unmask the false truths surrounding
mental illness. Dealing with aggression did not mean managing it through ‘good
government’, but rather transforming it into non-violent action and political
engagement within the life of the community, thereby precipitating a crisis within the
community itself. This was especially important when the community made a
rhetorical use of the notions of belonging, inclusion and citizenship, while continuing
to define the members of that community in terms of a norm and a single model of
health. Basaglia was well aware that the crisis of the social organisation began with
breaking down the walls of the asylum, but did not end with patient’s return in
society. And while the therapeutic and the political can intertwine in myriad ways,
not all these ways guarantee freedom, even when they function in terms of
integration.

The political transformation of reality which Basaglia had in mind occurs in
specific stages: from the dismantling of exclusion to the expanded participation of the
population and, ultimately, the criticism of the operators and their work. For
Basaglia, it was the growing conflict within a community due to the release of
inmates from a psychiatric hospital that created the conditions for a true exercise of
democracy. It was precisely at the moment that the community was being violated
that operators had to appear as a new breed of technicians who were willing to take
responsibility for their actions, helping residents to understand what was happening
and enabling former inmates to rediscover active roles and social ties. It was through
this intertwining of the therapeutic and political that psychiatry helped build
democracy. The science of social control, having passed through the death of the
asylum, was rehabilitated when it placed its own role and knowledge in crisis,
thereby forcing society to reconsider its logic of exclusion.

However, the fact that a total institution entered into crisis did not
automatically guarantee that this would be the outcome. Basaglia was well aware
that shutting down asylums did not necessarily preclude that same logic of social
control being reestablished in society. During his visit to the United States in 1969,
for example, his view of the de-hospitalisation begun during the Kennedy
administration, was quite negative. The creation of Mental Health Centers clearly
showed the shift from and, at times, the direct overlapping of the repressive
psychiatric power of the asylum onto the physical organisation of a capillary and
pervasive bio-power that had little therapeutic value but a strong mandate for social
control in daily life. This approach proved to be a failure because it gave rise to the
development of a private community-based care network that excluded poorer
patients, who were consequently abandoned. As Basaglia noted: ‘A portion of the
inmates thus ended up on the street, where social control was carried out
spontaneously, given that poverty is the best form of social control, and the best form
of psychiatric therapy’.12 In other words, it was not sufficient to close psychiatric
hospitals in order to promote an effective emancipation process, if former inmates
were then left to fend for themselves on the street. A de-hospitalisation plan aimed
solely at reducing public healthcare costs had nothing to do with a
deinstitutionalisation project inspired by the effective restitution of the rights of
citizenship to interned men and women.13 The former approach meant decisions made
from above by technicians and politicians without the participation of either the
persons involved or the general public, inevitably leading to abandonment in
conditions of poverty and marginalisation, or social control. Basaglia cites several
experiences to demonstrate this view. For example, during a team meeting in one
such Mental Health Center, the rector of New York University appeared to request a
psychiatric evaluation of the leader of the student revolt currently taking place. The
Center was thus viewed explicitly as a tool which could be used to help repress the
student political movement.14 Another example occurred during the home visit to a
woman who received a subsidy from the social services. When the social workers
discovered a pair of men’s underwear they immediately cut off her subsidy, accusing
her of concealing a companion who was perhaps also providing her with financial
support.15 These episodes of institutional stupidity or cynicism could be interpreted
reductively as the fault of single individuals or specific organisations. But they could
also indicate something very different. Basaglia never uses the term ‘bio-politics’ but
it seems this is precisely what he is speaking of.

During the 1970’s, the trajectory of Basaglia’s thought and that of Michel
Foucault, despite their very different points of departure, appear as remarkably
similar. For the French philosopher, in modern society the physical lives of human
beings have acquired a major ‘political’ significance.16 Governing means the rational
management of the social body, considered not only as an economic but also a
biological reality. For Liberalism, the rationality and effectiveness of government
depends on its ability to make society ‘more secure’, whether dealing with shortages
of wheat or inflation, or managing phenomena such as smallpox or tuberculosis.
Hence, the importance of a series of what can be considered ‘bio-political’ security
apparatuses, by means of which health issues are inscribed in a medical-political
approach.17 Psychiatry is paradigmatic here, for it did not originate as a new medical
specialisation but as a specific institutionalised branch of public hygiene.18 An
examination of public healthcare policies from the 18th century onwards shows that
the professional role of psychiatrists was not that of therapists, but rather of
hygienists, and it was in this role that they became important government advisors,
with direct administrative functions.19 Alienists were not only physicians specialised
in the treatment of mental illnesses, they were also hygienists concerned with
protecting society from the risks and dangers associated with such pathologies. The
1838 law establishing asylums in France originated in a therapeutic pact which,
however, concealed the issue of public safety. Thus, from alienism to the hunt for
degenerates, down to the psychiatric reforms of the 20th century, the history of
psychiatry would be characterised by the halting progress of a practice in constant
tension between the two poles of its dual ‘vocation’: the therapeutic and bio-security.

Although Basaglia never refers to ‘bio-politics’, his discovery that from the
very outset psychiatry had performed a social-political function mirrors Foucault’s
own conclusions. Indeed, his entire career can be seen as evolving out of a
fundamental imperative and question as to whether the time had finally come to
engage in a public, democratic debate concerning this function. There had never been
a deep debate on this issue because the scientific and therapeutic aspects had always
provided a screen for the social and political aspects underpinning them. The question
was how to keep the debate from being once again blocked, inhibited, neutralised.
How deal with the problem of the transformation of psychiatry without permitting
society to once again avoid assuming its responsibilities? Basaglia’s response, which
drew on his own phenomenological training, was both simple and radical: only by
placing mental illness ‘in parentheses’ was it possible to address the issue of how the
mentally ill are governed in our society, and at what cost. And while Basaglia does
not use the term bio-politics, he was convinced that the psychiatric question could not
be reduced to denouncing the conditions of inmates in asylums. In an article written
in 1967, and thus before the publication of L’Istituzione negata and prior to his visit
to the United States, he declares explicitly that psychiatry ‘must refuse any solution
based on reform and enable the mentally ill person to attain the level of opposition
and protest, which means not only the refusal of his previous role as an excluded
person but also his future role as an integrated one’.20

Basaglia realised that the problem was not the asylum per se, but rather the
political rationale which underpinned it and of which it was the expression. This
more general rationale, which we can call bio-security, was not necessarily nullified
by eliminating the asylum with its disciplinary mechanisms and its logic of exclusion.
Indeed, asylum reform could even prove to be functional to the process of
‘modernising’ the psychiatric system, for alongside the humanitarian scandal of the
asylum, there was the political scandal of the reformist interpretation of the
transformation of psychiatry. From the very outset, Basaglia sought to link the
negation of the asylum with a critical analysis of the rationale which sustained it. The
asylum possessed a ‘spirit’ as it were, and could not be eradicated without first
subverting the rationale of which it was one of the historical and institutional
manifestations. Many of Basaglia’s affirmations, which belie the stereotyped image
of the fanatic obsessed with destroying the asylum, can be explained by this early

fundamental awareness. The Brazilian conferences are sprinkled with these ‘odd’
views on the asylum. On various occasions, Basaglia plays down the political
significance of the abolition of the asylum, thereby situating the anti-institutional
struggle which had been pursued with such determination and with such important
results in Italy, in a more relative perspective. Such views appear as even more
significant if we consider that Basaglia was speaking in the context of the horrific
reality of asylums in Brazil, where psychiatry had yet to enter the modern era.

While it was undeniable that asylums continued to exist and had to be
abolished because they constituted the heart and sinews of the traditional psychiatric
system, Basaglia did not hesitate to define them as ‘antiques’.21 In fact, for some time
they had been undergoing a metamorphosis which presented new challenges.
According to the logic of alienism, the asylum was a place where the mentally ill
were treated and cured, while also providing a protective apparatus against their
social danger. Alienism entered into crisis when the asylum was shown to be an
institution that not only produced illness, but was also totally inadequate in terms of
providing effective, large scale prevention. Basaglia noted that the ‘new wave in
mental health’ insisted on the need to prevent rather than cure.22 But he was not
prepared to consider ‘prevention’ a value in and of itself, and instead questioned the
logic which underlay and placed such emphasis upon it. It was not enough to ask
‘what is psychiatry’.23 One must also ask ‘what is mental health’.

The recurrent references to French sector policies and the Anglo-Saxon
therapeutic community constitute the elements of a critical analysis that sought to
come to terms with the modernisation of the psychiatric system. As long as the
asylum continued to exist, the mentally ill would be governed by a disciplinary
technology and according to a logic of exclusion. But the asylum now survived
within more extensive apparatuses, where bio-political technology and the logic of
integration dominated. In fact, mental health apparatuses had created a new ‘object’
at the very moment in which they had responded to the question as to how to manage
that object. The focus had shifted from more severe forms of mental illness,
considered as being organic in nature, incurable and requiring internment, to mental
disorders which were less severe and transitory in nature, where the social component
was evident and which required a diversified intervention. The alienated, with their

delirium and scandalous behaviour, had become a minority. In advanced capitalist
countries the problem was how to manage the ‘deviant majority’,24 that is, the large
mass of those who were unable to compete adequately at the social and productive
level. As Basaglia notes: ‘The proliferation of marginalised persons today is very
high, much higher than during the period in which the first asylums were built. Are
asylums thus necessary and useful?’25

The ‘norm’ was no longer a conceptual cleaver that neatly divided the normal
from the pathological. The line of demarcation had blurred, making it possible to
‘cast a wider net’ over a statistically significant percentage of the population.26 The
new mental health apparatuses relied on registering the tiny oscillations of daily life –
inefficiency, non-adaptation, anti-social behaviours, etc. – and intervening upon a
differentiated normality. What was taking shape therefore, was a ‘psychiatry for the
normal person’.27 In purely technical terms, prevention could be seen as the attempt
to ‘flatten’ more deviant forms of normality onto those considered more normal, in
keeping with the imperative to render social and productive dynamics more certain
and secure. Denouncing the discrimination against the mentally ill was thus no longer
enough; it was now necessary to intervene upon normalisation processes that
involved the whole of society. This also explained why violence, authoritarian
coercion and repression was proving less effective than mass manipulation through a
calibrated use of freedom, tolerance and permissiveness.28

Basaglia sensed that his analysis had reached a point where his interlocutors
could no longer follow him. What was lacking was a common language, a shared
vocabulary. In speaking of the future he used the image of ‘a huge asylum that
envelops the city and which has replaced the original asylum’.29 The image, while a
bit naif, was hardly accidental. In fact, Basaglia had already expressed the same idea
in a number of scathing analyses that situated the psychiatric problem within the
more general context of medicalisation processes. ‘The real asylum is not psychiatry
but medicine,’30 for medicine is, in primis, a specific organisation of power relations.
The patient is in a statutory position of dependence with respect to the physician, and
this lack of reciprocity limits the areas of freedom and autonomy.31 Moving beyond
the scandal of the asylum meant beginning to question medicine as a form of the
political governance of human beings. Significantly, while Basaglia often invoked
‘human rights’ when denouncing the conditions of inmates, it was during this same
period that Foucault began to speak of ‘the rights of the governed’.

In this new context, focussing exclusively on the asylum-institution might
prove useless, if not counterproductive. The network of community-based services,
with their multidisciplinary and tendentiously ‘informal’ approach to mental
disorders, greatly attenuated the central role of the asylum. Instead, what most
concerned Basaglia in this new scenario was the overlapping of the old asylum
reality onto the new bio-political apparatuses, a development which ‘instead of
decreasing the number of users, increases them’.32 Reformist psychiatry had produced
a sort of temporal accumulation in which the ‘antiques’, duly renovated or
camouflaged, continued to exist alongside more modern structures and approaches.
Basaglia predicted that such hybrid systems would soon dominate. His time in the
United States had convinced him that this trend was rapidly becoming the dominant
model. During his second visit to Brazil, in November 1979, he was invited to speak
at Belo Horizonte together with Robert Castel who, with Françoise Castel and Anne
Lovell, had just published a study on the situation in the United States, with a second
study on the situation in France about to appear.33 What Basaglia saw taking place
around him struck him as a disturbing déjà vu. After 30 years of proposals,
transformation and struggle, he realised that the reality of the most advanced
psychiatric situations did not differ ‘substantially’ from the asylums of San Paolo or
Barbacena. The risk was that the more backward psychiatric situations, in evolving,
would follow exactly the same path towards modernisation as in the more developed
countries, creating a vicious circle, without breaks or alternatives.

In order to break this circle, the Italian experience could serve as a factor of destabilisation
or resistance, demonstrating that it was possible to take a different path
in the reform process. This explains why Basaglia refused to propose either a model
or an anti-model. The Italian experience, from Gorizia to Law 180, was a sort of wild
card which made it possible to view the transformation of psychiatry in a different
light. Modernisation was not inevitable, something predestined, to be either accepted
or refused. On the contrary, reform processes should be undertaken in the awareness
that they contained margins for manoeuvre. They were not trains hurtling through the
desert, in which one either got on board or remained stuck forever in the past. During
this journey there were branchings, and one need only seize the opportunities as they
appeared.

By straying from the established route, it was possible to make discoveries.
Foremost among these was that it was possible to steal a march on modernisation.
After 20 years of experimentation and struggle, of public participation and debate
with political parties and labour unions, the reform process had taken root in Italy and
become an opportunity for civic and democratic growth. This meant that the
transformation process was not necessarily synonymous with modernisation. Or,
better, that reform processes did not necessarily have to adhere to a reformist logic. It
was possible to reform psychiatry in practical and legal terms without gradual
institutional reform and without first reforming the asylum. When Basaglia declared
that the Italian experience proved that the impossible can become possible, he was
referring to the destruction of the Trieste asylum. However, if the problem was not
the asylum per se, Trieste also showed that reform could be achieved by taking a
‘radical’ and not a reformist path.

In the Gorizia Psychiatric Hospital, in the early 1960’s, Basaglia experimented
with a therapeutic community based on the model first applied by Maxwell Jones at
Dingleton Hospital, in Melrose, Scotland. He soon realised, however, that the
community model was simply a more efficient way of managing the social and
economic problems associated with the mentally ill. In Gorizia, the scandal was
political and exploded within a daily practice that was experienced by participants as
a militant commitment. The dilemma operators faced was how to carry out a
humanitarian and therapeutic project which, however, remained within the
framework of a reformist logic. The result was a lacerating contradiction. Basaglia
therefore decided to change strategy, abandoning the community reform project and
pursuing a reform that took into account the possibility of an ‘institutional caesura’ or
break. This break occurred within the reformist dynamic and indicated a resistance to
or rejection of the idea that reform could only be a by-product of modernisation,
which was only a more advanced stage in the art of governing the mentally ill. The
therapeutic community appears as a turning point in the liberal and bio-political
renewal of psychiatry, and explains why Basaglia was so attentive to mental health
apparatuses so early on and also perhaps why he felt a greater affinity with the French
experience of institutional psychotherapy, with its linkage between the therapeutic
and political dimensions. In this approach, at the outset at least, there was a break
with the simple logic of a more liberal management of the mentally ill. The English
therapeutic community, with its figure of the ‘psychiatrist-executive’ (so roundly
criticised in L’Istituzione negata) was instead contained completely within this logic,
and appeared as a direct evolution and consequence of alienist management.

The asylum had to be eliminated. And not because of some humanitarian
impulse wound up to an extremist pitch, but for essentially strategic reasons. For the
asylum was the great guarantor. It guaranteed psychiatrists that power relations
would be left intact, and that their identity would not be effected adversely, while
also assuring society that it could continue to enjoy a reasonable degree of security
without having to assume any specific responsibilities. Only the abolition of the
asylum could breach this wall of guarantees, shifting the reform process onto an
uncharted terrain where all the actors were called into question and daily practice
went to the very heart of the problems involved. It was the radical nature of the issues
being posed which constituted the core of the transformation process. Psychiatrists
were no longer the masters of the situation, for they now had to confront the
opposition and protest of the inmates who claimed the right to question the logic and
methods by which they were being managed. Their role as psychiatrists entered into
crisis, and their subjectivity was called into question, becoming the theatre of a ‘real
inner battle’.34 A difficult process of ‘redemption’ began for psychiatrists, for any
rehabilitation of the mentally ill was inconceivable without first committing oneself
to a profound internal transformation.35 Similarly, society could no longer ignore the
problem of the mentally ill, washing its hands of this problem and delegating
technicians with the task of walking a fine line between the demands of care and
those of security. Patients were beginning to return to their former neighbourhoods
and communities, and it was necessary to come to terms with their presence, to
engage in discussions and take a stance for or against. The whole of society was
being called into question, and its civic and democratic identity put to the test.
Recognising the rights of the mentally ill required a profound transformation not only
of the institutions and legal framework, but also of attitudes and culture.

These were radical issues because they did not derive from abstract conjecture
but instead grew out of ‘practical action’.36 Operators worked for the destruction of
the asylum and the creation of a network of community services, and accompanied
patients in their processes of social reintegration. They were the ‘lees’ of the reform
process, the humus from which a profound dynamic of transformation and resistance
that went beyond the logic of modernisation could materialise and grow, and which it
would be difficult to reverse. Basaglia rejected the either/or alternative of reform and
revolution. In his view, implicit in both alternatives was an attempt to impose a moral
imperative: on the one hand, the obligation to not reject a management model unless
another one was ready to take its place, on the other, a total overthrow of society
without which no authentic transformation would ever be possible. What sense was
there in fighting against the asylum if this only opened the way for new forms of
social control? Was the expression ‘power always gains the upper hand’ true for
psychiatry as well?37 Basaglia rejected this form of moral blackmail and returned the
revolutionary imperative to the extremists. Indeed, one of the basic themes of the
Brazilian lectures is that of revolution. Caught between the disillusionment with
social realism and the extremism of the Red Brigades,38 Basaglia offers a series of
acute insights which recall some of Foucault’s positions during the same period. As a
‘specific’ intellectual, what interested him was the possibility of intervening on
concrete mechanisms of power, especially within the doctor/patient relationship. A
total change in the social organisation did not necessarily mean that this relationship
would be transformed. Just as revolutionary processes can leave certain power
relations intact, so reform processes can produce substantial changes. The radical
nature of the transformation in question had its own specificity and could not be
contained within rigid conceptual grids.

Basaglia especially refused the idea of revolution as a form of Last Judgement.
It was illusory to think that some future time held the definitive answer to every
question. This was a dangerous illusion because the Messianic expectation of a brave
new world provided technicians with a formidable alibi. During a debate in Rio de
Janeiro, a psychiatrist argued that it was absolutely useless to engage in local,
immediate struggles like that against the asylum, if the great social and economic
problems were not resolved first. Basaglia replied: ‘I have the impression that you
are God and that we speak two completely different languages’.39 He detested the
‘pessimism’ of technicians who embraced theoretical extremism in order to justify
their inaction or sublimate their bad faith. There is a phrase of Antonio Gramsci
which recurs like a refrain during these conferences: ‘pessimism of the reason,
optimism of the will’. 40 This maxim has often been interpreted as a generic
devaluation of the intellectual sphere in favour of an equally generic exaltation of the
‘practical’. In reality, it is a barb aimed at a very specific target: the ‘beautiful souls’
who used theory to avoid reality and decide for others what needed to be done.
Basaglia distances himself decisively from a series of figures prevalent during this
period: the universal intellectual who offered visions of the world and showed others
the path they must follow, the intellectual who prophesied a brave new world, the
false prophets who preached armed struggle and the technicians who allowed
themselves to be beguiled by the revolutionary discourse in order to gain some
personal or corporate advantage. Basaglia never renounced his critical – especially
‘historical-critical’ – capacity. The historical analyses scattered throughout these
lectures, while brief and fragmentary, are of great interest and lend an uncanny
quality to his arguments. Being optimistic in terms of practice does not mean having
only ‘positive’ thoughts.

The rejection of revolutionary discourse, which just like reformist discourse
disqualifies real transformation processes, does not imply a reduced political
commitment in favour of a more pragmatic approach. In Italy, the various
movements for political and civil rights lasted longer than in other countries, but by
1979 there was a perceptible falling off in political militancy in favour of a neoliberal
model.

Basaglia insisted on the ‘subjective’ component of this political militancy. In
some personal digressions on his family (in which he was perhaps unduly harsh and
unjust with himself) he confessed to being a good revolutionary, but a poor father
and husband. If he insisted on this aspect, it was certainly not in favour some sort of
subjective or individualistic involution but in order to define an important aspect of
the movement during the ‘60’s and 70’s. The radicalism of the anti-institutional
movement in Italy cannot be explained by its ideological options or political
credentials, but rather by its ethical implications. Transformation can only occur if
there is also a ‘transformation of the Self’. As we noted earlier, the profound
transformation that results from placing ourselves in question, shedding our former
self and discovering that we are someone else is what makes this a process so
difficult to reverse, whatever the reformists may think.

Basaglia never abandoned the revolution. Instead he tried to ‘save it’, precisely
at a time in which he saw some of the areas that had been opened during the previous
two decades beginning to close again. This raises the question of how one becomes a
militant, what subjective journey must be undertaken in order to ‘convert oneself’ to
revolution. The only plausible response is that ultimately revolutions will always
disappoint us, unless we succeed in finding them first and foremost ‘within
ourselves’.41

 

 

1 F. Basaglia, Conferenze brasiliane (1979), Raffaello Cortina Editore, Milan, 2000, p. 142.

2 Ibid

3 The San Paolo asylum , Juqueri, alone had 18,000 inmates.

4 F. Basaglia, Conferenze brasiliane, cit. p. 53.

5 Ibid, p. 28.

6 Ibid, p. 143.

7 Ibid, p. 144.

8 Ibid, p. 194.

9 Ibid, p. 171.

10 Michel Foucault divides modern political technologies into ‘discipline’ and ‘bio-power’. For the analysis of prison
discipline see M. Foucault, Surveiller et punir (Paris, Gallimard, 1975); for asylum discipline see M. Foucault, Le
pouvoir psychiatrique. Cours au Collège de France (1973-74) (Paris, Gallimard, 2003).

11 F. Basaglia, Potere e istituzionalizzazione. Dalla vita istituzionale alla vita di comunità (1965), in Scritti, 2
vols., Einaudi, Turin 1981-82, vol. I, p. 293.

12 F. Basaglia, Conferenze brasiliane, cit. p. 222-223.

13 See. A. Lovell, N. Scheper-Huges, The utopia of reality: Franco Basaglia and the practice of a democratic
psychiatry, introduction to Psychiatry inside out. Selected writings of Franco Basaglia, Columbia University Press,
New York 1987.

14 F. Basaglia, Conferenze brasiliane, op. cit. p. 52.

15 Ibid

16 M. Foucault, La volonté de savoir, Gallimard, Paris 1976.

17 M. Foucault, Sécurité, territoire, population. Cours au Collège de France (1977-78), Gallimard, Paris 2004.

18 M. Foucault, Les Anormaux. Cours au Collège de France (1974-75), Gallimard, Paris 1999.

19 M. Foucault, La politique de la santé au XVIII siècle, in Id., Dits et écrits. 1954-1988, 4 vols., Gallimard, Paris1994, vol. III, pp- 13-27.

20 F. Basaglia, G. Minguzzi e F. Ongaro Basaglia, Esclusione, programmazione e integrazione. Appunti sulla
realtà psichiatrica italiana, in F. Basaglia, Scritti, op. cit., vol. I, p. 417. See F. Basaglia (ed.), L’institution en négation.
Rapport sur l’hôpital psychiatrique de Gorizia (1968), Paris, Seuil Combats, 1970.

21 F. Basaglia, Conferenze brasiliane, op. cit. p. 133.

22 Ibid, p. 140.

23 See F. Basaglia (ed.), Che cos’è la psichiatria ?, Amministrazione provinciale di Parma, Parma 1967 ;
Einaudi, Turin 1973 ; French translation : Qu’est-ce que la psychiatrie ? , Paris, PUF, 1977. This was the first book by
the Gorizia team, published in 1967.

24 See. F. Basaglia, F. Ongaro Basaglia (ed.), La maggioranza deviante. L’ideologia del controllo sociale totale,
Einaudi, Turin 1971; French translation: La majorité déviante, Paris, UGE 10/18, 1971.

25 F. Basaglia, Conferenze brasiliane, op. cit. p. 50.

26 Ibid, p. 52.

27 Ibid, p. 190.

28 Ibid, p. 51.

29 Ibid.

30 Ibid. p. 181.

31 Ibid, p. 81, 92 & 147.

32 Ibid, p. 189.

33 R. Castel, F. Castel, A. Lovell, La Société psychiatrique avancée : le modèle américain, Grasset, Paris 1979;
R. Castel, La gestion des risques. De l’anti-psychiatrie à l’après-psychanalyse, Les Éditions de Minuit, Paris 1981.

34 F. Basaglia, Conferenze brasiliane, op. cit. p. 193.

35 Ibid, pp. 38-39.

36 Ibid, p. 143.

37 Ibid, p. 53.

38 It should be recalled that the 1970’s were a period of extreme political violence in Italy, with dozens of
homicides and bombings. For example, on May 9, 1978, just 4 days before the ratification of the psychiatric reform act, Law 180, the Italian prime minister Aldo Moro was brutally murdered by the Red Brigades after being kidnapped and held prisoner for several months. Basaglia would always be firmly opposed to terrorism. In 1980 he wrote «Today, in the very tense situation in which we find ourselves, there are those who say that terrorism has opened up areas of struggle, has opened up contradictions. This is sheer madness, as is the view that the Red Brigades are an alternative to the State. Instead, the Red Brigades are a mirror image of the State. Opening up contradictions is something which is much more difficult and complex.» (F. Basaglia, “Conversazione: a proposito della nuova legge 180”, in Scritti, op. cit., vol. II, pp. 480-481). See also F. Basaglia, Conferenze brasiliane, op. cit., p. 128 e p. 143; F. Basaglia, F. Ongaro Basaglia, A. Pirella, S. Taverna, La nave che affonda. Psichiatria e antipsichiatria a dieci anni da “L’istituzione negata”: un dibattito, Rome 1978, pp. 68-69.

39 Ibid, p. 157.

40 Gramsci actually lifted this phrase from Romain Rolland, who may have found it in the writings of Malwida
von Meysenbug where it refers to the transcription by one of Nietzsche’s students of Jacob Burckhardt’s lectures on
Greek civilisation. It was Burckhardt who used the formula ‘pessimistic world view, optimistic temperament’ in order
to define the essence of the ancient Greeks. ” (see. M. Montinari, Nietzsche, Editori Riuniti, Rome, 1996, p. 103).

41 F. Basaglia, Conferenze brasiliane, op. cit. p. 195. Curiously, it was precisely at this same time that Foucault
was trying to define a “political spirituality ”, a research later developed during his course at the Collège de Franceentitled L’ermeneutica del soggetto (M. Foucault, L’herméneutique du sujet. Cours au Collège de France (1981-82), Gallimard, Paris 2001).

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