Presentation paolo tranchina teodori icmi venezia 2012
Paolo Tranchina e Maria Pia TeodoriPsychiatric reform in Italy and the art work of psychiatric patients(With the collaboration of Teresa Tranchina)AbstractThis paper outlines the history and development of psychiatric reform in Italy.We consider the social and historical roots of the movement, such as the Resistance,against Nazism, the campaign for workers health rights and the student revolt of 1968,We discuss as well the cultural roots that include phenomenology, the therapeuticcommunity of Maxwell Jones, American institutional sociology, Erving Goffman, historicalcritical reflection: Michel Foucault,. We examine the institutional and socio-politicalenvironment of the years 1960s in which the reform was born end developed, touching ondifferent aspects of the processes, the legal situation and the system that led to the totalelimination of psychiatric hospitals,replaced by psychiatric wards in general hospitals,family homes, therapeutic communities, and working cooperatives of patients.We then describe the different types of artwork created by psychiatric patients and discusshow these are been marketed to the public, rather than being relegated to the realm oftherapeutic entertainment.We begin by examining the socio-political, institutional and culturalaspects that formed the basis of Italian Law 180, often called theBasaglia Law.The introduction of this mental health act in may 1978 was preceded(and followed) by widespread debate, not only among politicians andexperts, but also common citizens, parties, trade unions, and variousspecial interest groups.Franco and Franca Basaglia sought to arouse public interest in mentalillness to foster resistance against isolation, and counteract thestigmatization processes.Of particular interest were the debates concerning compulsorytreatment, referred to, by someone, as sanitary arrest.Fortunately the choice was made to reserve beds in general hospitalsfor the treatment of acute cases: “The psychiatric services of diagnosisand therapy”.This pragmatic solution made it possible for Law 180 to be passed.The social and political aspects underlying Law 180 are connected tothe Resistance Movement against Nazism and Fascism, the campaignfor workers rights in health care in 1960, the 1968 student protests.Franco Basaglia being a partisan, that is a member of the Resistance,was arrested and imprisoned for six months at the end of the WorldsWar II. He, thus, had personal experience with total institutions andthe psychological states of grief, depression and depersonalizationprovoked by the loss of personal freedom. The walls of his psychiatrichospital in Trieste are still emblazoned with the words: “La libertà èterapeutica”, “Freedom is therapeutic”.Italy in the sixties was characterize by protracted struggles of theworkers to safeguard their health in factories. These struggles whereextremely radical and called for MAC ZERO, or, the total elimination ofthe maximum acceptable concentration of pollutants, powders, noises,
and so forth in all working environments. Quoting one of their slogans:“Health cannot be sold”, we like to think that the strong relationshipbetween “MAC ZERO” and “PSYCHIATRIC HOSPITALS ZERO”, whichreflected the spirit of the times, made it possible the impossible, thatis: the concrete utopia that led to the closing down of all psychiatrichospitals in Italy.The book “L’istituzione negata”, “The Negated Institution” recountsthe experience of deinstitutionalization at the Psychiatric Hospital ofGorizia, conducted by Franco Basaglia.Published in 1968, the book was enthusiastically received by studentsfighting for a new world, who adopted it as a guide for their longmarch through institutions, along with the lines of Mao Tze Tungmodel. Many students channelled their revolutionary feelings into anti-institutional struggles. The East Wind swelled our sails.The Italian institutional situation was very bad. No technical,organizational, and architectural reform had been made. There wasthus an unbearable contradiction between backward psychiatrichospitals and the economical “boom” of the year sixty that waspushing Italy towards modernization.The cultural situation was dominated by organicism, psychoanalysisdidn’t have any hegemony. Basaglia and his équipe inspiredthemselves to the English therapeutic community of Maxwell Jones,Lucio Schittar a member of the Gorizia équipe, attended for a longperiod Jones’s psychiatric hospital, in Scotland. Franco Basaglia wasalways very respectful of Jones’ work, even if he criticized thetherapeutic community as a golden cage, replacing it by a multiplerelation of the hospital with the local community: citizens, parties,trade-union, etc.Very important was the relation with phenomenology, from which themovement used the concept of phenomenological époque, that is thesuspension of the judgment. We called it “to put mental illness intobrackets” (messa tra parentesi della malattia mentale) that made itpossible the therapeutic encounter with the patient, out of traditionalpower and role problems,American sociology (Erving Goffman) had a certain importance, as wellas the fundamental critical thought of Michel Foucault.We are going now to examine the fundamental aspects of the Italianreform.1) We think the 180 Law has a very high ethical frame, centred on thedignity and valorisation of the patients. We think that psychiatrichospital cannot be reformed, they cause very deep forms on
institutionalisation and are unable to answer to the needs ofsubjectivity of the patients. Therefore they must be eliminated.2) The work inspired itself to the “paradigm of the last”, “paradigmadell’ultimo”, that is to the need to start always from the heaviestpatients.3) Action and thinking are going on together because our duty is toempower our patients concretely as well as psychologically.4) Assembly has been privileged as therapeutic instrument. In thepsychiatric hospital of Arezzo, directed by Agostino Pirella, there wereweekly 37 meetings. Individual and family meetings where usedwidely as well.5) The rehabilitation inside the hospital has been carried oncontemporarily with the work in the community through mental healthcentres, family houses, domiciliary visits, etc..6) In our work we used the institutional analysis, that is thesystematic effort to connect any personal behaviour, symptoms, etc.not only to individual and family situations but also to the institutional,social and political ones.7) Fundamental in our practises has been to work in very strictrelation with nurses, volunteers, etc.. We call it “lavoro fianco afianco”, “Side by side work”. It is very important in order to discussinstitutional powers and favour collective, participation in therapy.8) The work of patients is very important .The old ergotherapy hasbeen abandoned and substituted by cooperatives, social enterprises,etc. that offer to the patients a new healthy identity, that opposepathological processes.9) Participation has been a basic aspect of deinstitutionalisation, notonly for all the members of institutions, but for all society. In the yearspreceding the 180 Law, Franco and Franca Basaglia published at leasta monthly article in the most important Italian newspapers. Sometimes two articles in the same day. Madness has become a matterdebated collectively, in the community, not only by experts.To the participation processes has contributed also the review Foglid’Informazione, directed by Paolo Tranchina a Agostino Pirella, that inthe last 40 years has published 120 issues and 37 books, for some13.000 pages. At the beginning, since the naissance of the associationDemocratic Psychiatry, all the issues were debated in meeting held indifferent cities.
10) We think that our best practices belong to the field ofpsychotherapies of psychoses. We owe much to Freud, Bleuler, Jung,Federn, Sullivan, Frieda Fromm Reichmann, etc., even if we areapplying their teaching in a very creative manner.The application of 180 law has been homogeneous in the totaleliminations of psychiatric hospitals but not homogeneous al all in thequality of community services. Some service are very poor, basedexclusively on hospital admittance and ambulatory drug treatment.For example, only 20 Services of cure and diagnosis over some 300,work in a complete system of open door and without using physicalrestraint at all. Many times – bat not always - the poor style of work isconnected to heavy cuts to the sanitary expenses.The deinstitutionalization processes have involved all childreninstitutions and children mental health. Special schools and specialclasses in normal schools have been closed. In the community werecreated infancy and adolescence services. All children, handicappedboth at the psychic or physical level, have been put in normal classes,helped by specialized teachersIn these months the Italian Parliament passed a law for the totalelimination of all the judiciary psychiatric hospitals. It will be surely along battle because the penal code has not been modified, but in thelong run we will close them as all other psychiatric hospitals.Art work with psychiatric patients Art and beauty are fundamental aspects of life and importantelements of therapy, both for mental and organic illness.The Italian experiences in this field are characterised by two aspects.The first is the development of individual creativity. The second is theutilization of the production for the market, and not as entertainment.This empowers the identity of the patients both at the aesthetic leveland to the economical one.The works of art are very important non only for the artists bat foreverybody and particularly for ill people. The centaur Chiron,Asclepius’ master, cures with drugs bat also with music, whoseharmony helps the patient to find again its lost equilibrium, TheHospital Santa Maria Nuova, in Florence, founded by Fosco Portinari,and appreciated also by Luther, had, in the Renaissance, some 500works of art. Art helps us to live, because its establish again an orderand balance that illness has broken. It works as well as a powerfulinstrument of symbolic realization, and creative imagination thatoppose psychotic emptiness.Conclusions
In Italy psychiatric hospitals have died, but their ideology stillcontinues its regressive work. Just this month passed a bill proposalthat makes it possible long therapeutic compulsory admissions inclosed institutions, masking of therapy simple economical interests.This proposal appears to be a regressive answer to the advancedrecent law that will make it possible the total elimination of judicialpsychiatric hospitals.NotesWe thank Dr. Caterina Corbascio, head psychiatrist, and Prof. Fabio Malavasi, universityteacher of genetics, in Torino, for their correction of our paper.