1. Paolo Tranchina e Maria Pia Teodori
Psychiatric reform in Italy and the art work of psychiatric patients
(With the collaboration of Teresa Tranchina)
Abstract
This 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 therapeutic
community of Maxwell Jones, American institutional sociology, Erving Goffman, historical
critical reflection: Michel Foucault,. We examine the institutional and socio-political
environment of the years 1960s in which the reform was born end developed, touching on
different aspects of the processes, the legal situation and the system that led to the total
elimination 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 discuss
how these are been marketed to the public, rather than being relegated to the realm of
therapeutic entertainment.
We begin by examining the socio-political, institutional and cultural
aspects that formed the basis of Italian Law 180, often called the
Basaglia Law.
The introduction of this mental health act in may 1978 was preceded
(and followed) by widespread debate, not only among politicians and
experts, but also common citizens, parties, trade unions, and various
special interest groups.
Franco and Franca Basaglia sought to arouse public interest in mental
illness to foster resistance against isolation, and counteract the
stigmatization processes.
Of particular interest were the debates concerning compulsory
treatment, referred to, by someone, as sanitary arrest.
Fortunately the choice was made to reserve beds in general hospitals
for the treatment of acute cases: “The psychiatric services of diagnosis
and therapy”.
This pragmatic solution made it possible for Law 180 to be passed.
The social and political aspects underlying Law 180 are connected to
the Resistance Movement against Nazism and Fascism, the campaign
for 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 Worlds
War II. He, thus, had personal experience with total institutions and
the psychological states of grief, depression and depersonalization
provoked by the loss of personal freedom. The walls of his psychiatric
hospital in Trieste are still emblazoned with the words: “La libertà è
terapeutica”, “Freedom is therapeutic”.
Italy in the sixties was characterize by protracted struggles of the
workers to safeguard their health in factories. These struggles where
extremely radical and called for MAC ZERO, or, the total elimination of
the maximum acceptable concentration of pollutants, powders, noises,

2. and so forth in all working environments. Quoting one of their slogans:
“Health cannot be sold”, we like to think that the strong relationship
between “MAC ZERO” and “PSYCHIATRIC HOSPITALS ZERO”, which
reflected the spirit of the times, made it possible the impossible, that
is: the concrete utopia that led to the closing down of all psychiatric
hospitals in Italy.
The book “L’istituzione negata”, “The Negated Institution” recounts
the experience of deinstitutionalization at the Psychiatric Hospital of
Gorizia, conducted by Franco Basaglia.
Published in 1968, the book was enthusiastically received by students
fighting for a new world, who adopted it as a guide for their long
march through institutions, along with the lines of Mao Tze Tung
model. 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 was
thus an unbearable contradiction between backward psychiatric
hospitals and the economical “boom” of the year sixty that was
pushing Italy towards modernization.
The cultural situation was dominated by organicism, psychoanalysis
didn’t have any hegemony. Basaglia and his équipe inspired
themselves to the English therapeutic community of Maxwell Jones,
Lucio Schittar a member of the Gorizia équipe, attended for a long
period Jones’s psychiatric hospital, in Scotland. Franco Basaglia was
always very respectful of Jones’ work, even if he criticized the
therapeutic community as a golden cage, replacing it by a multiple
relation of the hospital with the local community: citizens, parties,
trade-union, etc.
Very important was the relation with phenomenology, from which the
movement used the concept of phenomenological époque, that is the
suspension of the judgment. We called it “to put mental illness into
brackets” (messa tra parentesi della malattia mentale) that made it
possible the therapeutic encounter with the patient, out of traditional
power and role problems,
American sociology (Erving Goffman) had a certain importance, as well
as the fundamental critical thought of Michel Foucault.
We are going now to examine the fundamental aspects of the Italian
reform.
1) We think the 180 Law has a very high ethical frame, centred on the
dignity and valorisation of the patients. We think that psychiatric
hospital cannot be reformed, they cause very deep forms on

3. institutionalisation and are unable to answer to the needs of
subjectivity of the patients. Therefore they must be eliminated.
2) The work inspired itself to the “paradigm of the last”, “paradigma
dell’ultimo”, that is to the need to start always from the heaviest
patients.
3) Action and thinking are going on together because our duty is to
empower our patients concretely as well as psychologically.
4) Assembly has been privileged as therapeutic instrument. In the
psychiatric hospital of Arezzo, directed by Agostino Pirella, there were
weekly 37 meetings. Individual and family meetings where used
widely as well.
5) The rehabilitation inside the hospital has been carried on
contemporarily with the work in the community through mental health
centres, family houses, domiciliary visits, etc..
6) In our work we used the institutional analysis, that is the
systematic 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 strict
relation with nurses, volunteers, etc.. We call it “lavoro fianco a
fianco”, “Side by side work”. It is very important in order to discuss
institutional powers and favour collective, participation in therapy.
8) The work of patients is very important .The old ergotherapy has
been abandoned and substituted by cooperatives, social enterprises,
etc. that offer to the patients a new healthy identity, that oppose
pathological processes.
9) Participation has been a basic aspect of deinstitutionalisation, not
only for all the members of institutions, but for all society. In the years
preceding the 180 Law, Franco and Franca Basaglia published at least
a monthly article in the most important Italian newspapers. Some
times two articles in the same day. Madness has become a matter
debated collectively, in the community, not only by experts.
To the participation processes has contributed also the review Fogli
d’Informazione, directed by Paolo Tranchina a Agostino Pirella, that in
the last 40 years has published 120 issues and 37 books, for some
13.000 pages. At the beginning, since the naissance of the association
Democratic Psychiatry, all the issues were debated in meeting held in
different cities.

4. 10) We think that our best practices belong to the field of
psychotherapies of psychoses. We owe much to Freud, Bleuler, Jung,
Federn, Sullivan, Frieda Fromm Reichmann, etc., even if we are
applying their teaching in a very creative manner.
The application of 180 law has been homogeneous in the total
eliminations of psychiatric hospitals but not homogeneous al all in the
quality of community services. Some service are very poor, based
exclusively 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 physical
restraint at all. Many times – bat not always - the poor style of work is
connected to heavy cuts to the sanitary expenses.
The deinstitutionalization processes have involved all children
institutions and children mental health. Special schools and special
classes in normal schools have been closed. In the community were
created infancy and adolescence services. All children, handicapped
both at the psychic or physical level, have been put in normal classes,
helped by specialized teachers
In these months the Italian Parliament passed a law for the total
elimination of all the judiciary psychiatric hospitals. It will be surely a
long battle because the penal code has not been modified, but in the
long run we will close them as all other psychiatric hospitals.
Art work with psychiatric patients
Art and beauty are fundamental aspects of life and important
elements 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 the
utilization of the production for the market, and not as entertainment.
This empowers the identity of the patients both at the aesthetic level
and to the economical one.
The works of art are very important non only for the artists bat for
everybody and particularly for ill people. The centaur Chiron,
Asclepius’ master, cures with drugs bat also with music, whose
harmony helps the patient to find again its lost equilibrium, The
Hospital Santa Maria Nuova, in Florence, founded by Fosco Portinari,
and appreciated also by Luther, had, in the Renaissance, some 500
works of art. Art helps us to live, because its establish again an order
and balance that illness has broken. It works as well as a powerful
instrument of symbolic realization, and creative imagination that
oppose psychotic emptiness.
Conclusions

5. In Italy psychiatric hospitals have died, but their ideology still
continues its regressive work. Just this month passed a bill proposal
that makes it possible long therapeutic compulsory admissions in
closed institutions, masking of therapy simple economical interests.
This proposal appears to be a regressive answer to the advanced
recent law that will make it possible the total elimination of judicial
psychiatric hospitals.
Notes
We thank Dr. Caterina Corbascio, head psychiatrist, and Prof. Fabio Malavasi, university
teacher of genetics, in Torino, for their correction of our paper.