Franco Basaglia, the revolutionaryยทThe Italian Files
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Thea 0:00
On the 23rd of December 1978, Law number 180 was approved by the Italian Parliament and history was made. Italy would become the first country in the world to dismantle psychiatric hospitals. Behind this astonishing piece of legislation was the two decades long fight for the Venetian psychiatrists Franco Basaglia, one of the heroes of the so-called antipsychiatry movement who, inspired by the 1960s countercultural experiments of the British R.D. Laing and David Cooper, decided to fight the repressive nature of the psychiatric institution from within. Welcome to the Italian Files, a podcast of conversations about lesser known protagonists, themes and stories of Italian culture and society.

As the Medical Director of the psychiatric hospitals of Gorizia and Trieste, Franco Basaglia deeply transformed how we understand and treat mental health. He brought about a kind of revolution in the profession of psychiatry itself. But how did the Legge Basaglia, as it became known, come about? What were its connections with a uniquely fertile period of cultural history? And what is Basaglia's legacy today, more than 40 years after psychiatric hospitals ceased to exist in Italy? We'll discuss this and more with John Foot, Professor of Modern Italian History at the University of Bristol and the author of The Man Who Closed the Asylums: Franco Basaglia and the Revolution in Mental Health Care. And as Editor, with Tom Burns, Basaglia's International Legacy: From Asylums to Community, published in 2020. John Foot is with us now, John, hello.

John 1:57
Hello. Nice to be here.

Thea 1:59
Lovely to have you on. Let's begin at the beginning then: who was Franco Basaglia, and why is he still 40 odd years after his death, so present in the Italian and in in the international story of mental health.

John 2:11
So Franco Basaglia was born in Venice in the 1920s. He grew up in quite a rich family. But at the age of 19, he got involved in antifascist activities. Venice was occupied at that time by the Nazis, and was arrested and imprisoned as an antifascist as a teenager, and was only released with the liberation of Venice in 1945. He studied psychiatry at Padua University, and was very interested in philosophy and phenomenology and became interested in new ways of doing psychiatry, but his academic career wasn't really going anywhere. And the key moment become comes in 1961, when he's called or applies for a job as Director of a psychiatric hospital, in a place called Gorizia, on the edge of Italy, right on the edge of the Cold War border with Yugoslavia, a kind of place that was an interesting place in Italian history anyway. And he takes over this kind of provincial psychiatric hospital and then you get the start of the Basaglia's story, which is also enveloped in myth, in that he immediately rejects the logic of the psychiatric hospital that he has taken over. And begins already, from the first day in charge, to subvert the logic of the institution and to open up the asylum, which he sees as a place of torture, of segregation, or place, not really of care.

Thea 3:35
The scene when he entered it, the scene of psychiatric care in Italy was incredibly... well, old fashioned isn't a deep enough word, really. But it was it was it was almost, it was almost mediaeval, I suppose. And he came in and he, as you say, from day one, refused to bind people. And that was one of the main things that people would do, they would bind patients to their beds, they would isolate them, there was the isolation method which was very much a nuisance. All of this he just said, amazingly brave from the from day one, he just said, we're not doing that anymore.

John 4:10
That's right. I mean, he saw a situation where the patients had no agency at all over their situation, they were subjected to forms of containment and treatment, which they had no choice over. And, you know, often they're for years and years and years inside these grim asylums, 100,000 or so patients is probably the wrong word, people constrained inside these places. Yes, from day one, he began to change it, he refused to sign (which was kind of a praxis which had been going on for years) permission to tie people up, which, you know, it was already a change from the first thing that he was asked to do. But it took a long time because he didn't have any allies in the hospital. Everybody was, you know, within the logic of that idea of an institution. And he had to kind of get allies in and he had to fight against the local council, fight against the psychiatric. So he went very slowly, they didn't really know what they were doing. He didn't really know how to do this. He went around the world looking at other examples. And it's so it took a long time. And they slowly opened up the wards over a number of years.

Thea 5:22
And behind all of this was obviously some some really deeply investigated deeply felt theory, he basically was turning the idea of mental health care on its head, he insisted that the stereotypes that that we have of the mad, or that we had of the mad, you know, of them, of them hitting their heads against the wall, of these vacant stares, of all of these sorts of tropes, that were actually the consequence of the institutions rather than the consequence of the illnesses themselves. And this sounds so obvious to us now, I would think. But at the time, it really wasn't, that was quite a revolutionary way of looking at it, wasn't it?

John 6:03
Absolutely. And there were a number of texts, you know, this is something is happening on a global level that that Basaglia brings into it, a number of books and texts circulating from the early 60s, late 50s onwards. Goffman's Asylums, the work of Foucault, the work of R.D. Laing and the so called antipsychiatrists in the UK, so he is reading all this stuff, he's going around looking at places that have opened up more, and he's also applying that back, but through his own lens, into Gorizia, practically he very much was not just a theorist. He did like theory he did like philosophy. And Sartre was his kind of hero, if you like, but he very much believed that, you know, the practice was also important. He argued that when you had a person in front of you, who was a so called patient in an asylum, you suspended the diagnosis that they'd been given and you just spoke to him as a person. And you put yourself in the story as much as that. So, you know, he very much didn't go through the psychiatric logic, which was that this person was a schizophrenic, this person was depressed, this person was this, and therefore they were labelled and therefore they were there forever. He believed that the institution was damaging the people inside it and needed to be abolished, which was a pretty extreme position. In 1964, he came to London to a crazy conference, at the Quintin Kynaston School where I used to play basketball bizarrely, when I was a child in North London, a social psychiatry conference, he gave a paper on the necessity to destroy the psychiatric hospital which caused a bit of a stir but because even amongst radical psychiatrists, this wasn't the idea at that time. And you know, he was he was very firm in that belief, right from the start. That wasn't enough to reform you needed to get rid of this system.

Thea 7:48
He wasn't only doing that with the patients in mind was he was doing that with the doctors, the nurses and society as a whole. He was saying this institution doesn't serve anyone.

John 7:58
That's right. And he connected up. It wasn't just even about psychiatry, psychiatric hospitals alone, it connected up with schools, universities, prisons, you know, he said there were these these institutions which Goffman called total institutions, institutions of violence, he called them in quite an extraordinary piece that he wrote later in 1968. And this this whole movement in Gorizia, which goes on, you know... What he did in Gorizia was amazing, but no one really noticed it until around 1968. And it perfectly fits with 68. He starts having meetings of patients in 65 already with the meetings are run by the patients, and they discuss things. And there are incredible films of these if you want to go and watch them, and they vote on things. And this is an overturning of the of the institution. And in 68 this fits perfectly with what's going on in universities, schools, on the streets in the factories.

Thea 8:56
I was gonna say that, you know, we have to bear in mind that the very particular political climate, not just in Italy, but elsewhere at that time, the 1968 movement. His book, L'Istituzione Negata, The Institution Denied, that was very widely read, wasn't it? It really spoke to people in these other institutions, it really captured the mood.

John 9:16
Yes, it's extraordinary the timing of that book, March 1968, and it's a collection of of articles by what was by then a group of psychiatrist who Basaglia had managed to get employed in the asylum by fighting against the local council. And he got this kind of like minded equipe, he called it using the French word, a working group. And that book is a collection of articles, but also the voices of the patients, which had never really been heard before. There's an amazing interview with one of the patients who'd been in Auschwitz talking about comparing the psychiatric hospital with a concentration camp. She had literally been in Auschwitz, and then it ended up in the Gorizia camp. So this book really hits the Zeitgeist and it you know, become was a best seller, Basaglia becomes a household name at that point he's going around. He doesn't actually like that very much. He kind of likes it and doesn't like it. He likes it, but he finds it a bit distasteful as well. But you know, it was on everyone's shelves. And lots of people flocked to Gorizia, you know, to see what's going on, and they can't believe it. They walk in, asking where are the mad people were the normal people. There's no gates, there's no fences, people are wandering around. No one's got white coats on, I mean the doctors. So it's like the future, but in the present. Yes, an amazing place to visit in 68.

Thea 10:34
I suppose that that visibility that he got through his celebrity, would have been annoying for him. But he can't have denied that it would have helped him achieve what he wanted to do. Because that visibility was something that had been denied these people, these patients, for for so long. The very nature of the thing was that they will shut away so no one saw them.

John 10:56
That's right. And it starts to become a movement, it spreads to some other places. Similar things have been happening, for example, in Perugia in central Italy. And it spreads and the psychiatrists start to come to visit Gorizia, and to go back to their own institutions. And there's an amazing TV documentary made at the end of 68, which gets primetime exposure (11 million people watch it in Italy) called I giardini di Abele by a documentary maker called Sergio Zavoli, very well known. And this documentary has Basaglia in it walking up and down saying extraordinary things, it's a very famous documentary, and lots of people are affected by it. So you know, the exposure is huge. And this puts on the agenda, the fact that these places exist, which should for years have been more or less ignored by the general public and by political authorities.

Thea 11:45
I'm wondering if with the political situation in mind as Italy moved into the late 60s and then continues through to the early 80s, what is know as the "anni di piombo", the "years of lead", a time of intense political difficulty, is that an understatement, but an incredibly intense time when far right factions and left wing factions, there was terrorism, and it was a part of daily life. I'm wondering if there was a sense of urgency behind this reform as well. Was there a worry that psychiatry could be mal administered, weaponized, even with with political radicals, perhaps being locked away as mentally unsound? Was that something that fed into the thinking at all?

John 12:31
That happened under fascism, one of the tactics that Mussolini used in the 20s, and 30s, was to put subversives and oppositionists in the silence, similar to what I suppose happened under Stalin to some extent, and happens in other countries today. There was immense opposition to what he was proposing not just amongst many people in the general public, but also amongst the psychiatric establishment, you know, he was always in a minority voice amongst the psychiatric establishment. And you know, I think, right to the end, even today, you know, the the reforms, and the changes are still controversial. They divide Italians. And in those years of division and violence, this was one voice. Basaglia was a man of the left for sure, you know, but he didn't align himself with any particular party, particularly, he was very strategic in his trying to bring over the Communist Party, which is the huge party on the left, to his point of view, the Communist Party was very much in favour of psychiatric hospitals, not least, because that was a kind of rational in theory, way to organise mental health and also provided a lot of jobs to be honest. You know, in some places, in Parma, the the psychiatric hospital was called the FIAT of Parma because it employs so many people. You had lots of nurses, because nurses were basically very strong people who could suppress, physically, patients. They weren't trained in any way. Basaglia and the others, and the part of the movement, managed to bring them over to a point of view that was very progressive through political tactics, which were very clever, I think.

Thea 14:14
And for the nurses, he had a whole whole kind of reeducation in mind, and he thought that they needed to be reconnected with their humanity, that they had just become cogs in this in this brutal machine.

John 14:27
Yes. And I mean, amongst the nurses, there was division in every single hospital where this happened, half of them would be absolutely terrified, because they were losing their control and power and the patients were taking control. And others were very much on side and then a whole series of young people came to work in psychiatric care inspired by L'Istituzione Neagata and by the movement. I heard stories, I interviewed people when I was writing my book, stories of people turning up in Gorizia saying I want to be a psychiatrist. I want to work in this area or reading that book. And so you get a renewal of that whole class of nurses, a lot of them taken from the peasantry, you know, who know nothing about mental health. So it's an extraordinary renewal. And, and once Basaglia moves from Gorizia, Gorizia ends very badly, in many ways: there's a murder by a patient of the of the family members and a huge controversy over that in a court case, and so on. And he goes to Trieste, which is another much bigger city. And there he has full political backing, because there's a Christian Democrat politician who says, I will give you back in whatever happens, I will support you, we've got to close down this asylum, and we've got to reform it, here's a lot of money as well. And there he can kind of do whatever he wants. And that is the most famous part of the Basaglian experiment, what happens in Trieste in the 1970s. Because there you have a fully open hospital, but also getting the people out into society, which is the eventual aim of the Basaglian experiment, to not just close, but to reintegrate and revisit mental health in general, in society and the community.

Thea 16:13
Before we embark on the Trieste chapter there, let's take a few steps back. We've mentioned, you've mentioned the movement, the anti psychiatry movement a few times. So just bring us up to speed, if you could, how, how and where did that start? And what was Basaglia's relation to it, you mentioned that he spent some time presenting papers and discussing matters in in the UK.

John 16:33
It was all connected. I mean, these people spoke to each other, they exchanged texts, they argued with each other, Basaglia had a lot of connections in France, a lot of discussions with French psychiatrists, and radical psychiatrists, he knew Ronald Lange, and also exchanged texts, they also argued about lots of things. I mean, the whole movement was was conflicted and had arguments an division over tactics, over strategy. In France, they tended to keep the psychiatric hospital and argued you could create a new kind of psychiatric hospital, Basaglia was very much you need to abolish it, you cannot reform that institution. So very different positions, but it was a global movement. And these texts circulated and actually Basaglia became part of the Einaudi editorial committee, which was this very important publisher in Italy. And he managed to get numerous texts translated and published, which were very important for spreading the word, Laing, Goffman, all of these kinds of books, and work on women and psychoanalysis, a book by Juliet Mitchell, very important, came out in Italian thanks to Franco Basaglia and his wife, Franca Ongaro, who was an extraordinary part of the movement as well. There's also an attempt to organise radical psychiatrists in Italy, in a in a movement called Psichiatria Democratica. And so they have this huge congress in Gorizia in the 70s of all these psychiatrists, hundreds of them inspired by Gorizia and other experiments. And so there is an attempt to build a movement which is actually organised, which is, you know, again, very conflictual, but is an extraordinary thing as well. And they have newspapers and magazines and, and training programmes and so on. And they're still going today, they made me an honorary member of it once, which I was very proud of, they gave me a little card, and there's still people involved who not just, you know, now we're in a second generation after that, we can talk about the kind of backlash, perhaps a bit later, but some towards the end, but but, you know, the group in Gorizia went out and became directors of 10 asylums to close them down. And I think that's an incredible thing, right? What you're basically doing is saying, I want to abolish my own job, which is a very rare thing.

Thea 18:49
He hadn't stopped believing in psychiatry, had he. I mean, the term antipsychiatry, to be antipsychiatrist, he wasn't really that, was he. He didn't have a particularly happy relationship with the term itself because he did believe in psychiatry,

John 19:03
He hated the term and he saw the term as being used against him. You know, one of the classic accusations was Basaglia and others thought that mental illness didn't exist, which is completely wrong. They were well aware, in fact they were actually more aware of it than many other psychiatrists because they dealt so deeply with the patients, Basaglia would stay up all night talking to people you know, he tells these stories about his deep relationship with one of the patients he had an extremely good way to connect, as did Laing actually, with with people. He hated the term, the term was kind of used as a sort of battering ram, still is actually, and very few people embraced it, even Laing rejected it. So he would have called himself a critical psychiatrists or I used the term radical psychiatry, but they were still psychiatrists. They still practised, they still believed people needed care. They just believe that on a basic level, the mental hospitals or psychiatric institutions were not working in any way. And you need to decentralise what they set up with daycare centres, and different forms of care and different relationships with people with mental illness. They were halfway through that, you know, that was a long process. Because to set up those systems, you need commitment, you need money, you need councils and government on site.

Thea 20:23
And he got that to a great degree, as you say, when he gets to Trieste. So what happens from there? What year was it? And where do we go from that?

John 20:33
So in 1971, he has a little break. He goes to America for six months, and he has kind of burnt out, to be honest, by all the controversy and by you know, living in a psychiatric hospital every day is a tough call and dealing with patients and also dealing with a with a political movement, which is also something, so he burnt out. But in 71, he goes to Trieste and then everything explodes because he no longer wants to create a perfect asylumm, as he as he said, he said Gorizia had the danger of being a golden cage. So you create a beautiful democratic asylum, but you still got the asylum, he wants to get rid of it. And so he moves very fast in Trieste. So they start to get patients out some reforms have been passed in 68, which allow people to be put back into the community, they connect with the community in Trieste, they bring in all kinds of creative people, artists, music, concerts are held in the grounds of student movement, it kind of becomes like a kind of Woodstock of psychiatry. And and you know, it's and then it's an amazing experience. And in the end very practical, because they do manage to get hundreds of people out of the asylum into the city itself. Even though that is not the law, yet. The law come in 1978.

Thea 22:01
But it was very much this that gave him the foundation for that reform of 78.

John 22:06
Yes, I mean, he starts to push for national reform, because he knows along with the movement, that will without national reform of the laws, which are actually very antiquated laws came right back to that, you know, how people get him turned into asylums, and all that kind of thing.

Thea 22:20
So it was this experience in Trieste that kind of gave him the foundation for the reform of 78. So, so maybe let's skip along to 1978. Let's skip along to, to the Basaglia, reform, what were the immediate consequences.

John 22:33
So 1978 very problematic timing. It's the head of the Christian Democratic Party and former Prime Minister Aldo Moro, was kidnapped by the Red Brigades and held 55 days in Rome. And in this context of instability, and, and crisis, there's a referendum proposed to abolish the previous laws on mental illness, which are very old laws. And there's a danger of a complete lack of legislation. So referendums in Italy can be called to abolish laws, not to make new laws. And in that context, the party's kind of minds are concentrated the big political parties, the communists and the Christian Democrats, and they decide to reform mental health. And under the pressure of the Basaglia movement, under other pressure from reformist psychiatrists, they pass this famous law, which is called the Basaglia law, perhaps wrongly, but is often referred to as the Basaglia law. And it's a law that is very short, and, but is revolutionary stuff. And the law basically calls for the abolition of psychiatric hospitals, and said, You can't build any new ones. So the system is dead, it will then take 20 years to actually close them. So they can't You can't close a psychiatric hospital overnight, because you have 1000s of people to who are actually in them. But the law itself says we're going to close the asylums not because they cost too much, not because they are inefficient, but because they're morally wrong. They're not working for mental illness. And that's, you know, it's an it's an amazing moment. For Italy, and for the world.

Thea 24:08
How did that ripple out of Italy? How did how was it reported? How did people feel about it in, in the UK or in France, where, as you say, there were sort of there were differences in how they felt about the institution.

John 24:19
It's received very differently in different countries and our book on, on on the legacy shows how differently. In some countries, that's kind of complete rejection of it. A UK has great difficulty with it. And in fact, the left in the UK tends to defend the psychiatric hospital against the cuts. So there's a complete almost an overturning and Basaglia in that context is very dangerous, because he's saying you don't need psychiatric hospitals. And so and he's often dismissed as a Marxist in a sort of misdescribed in it and we kind of detail that. In other countries, there's an extraordinary, comes with revolutionary effects of the experience Brazil, for example, where Basaglia goes and speaks in the 70s in which is under a dictatorship. It almost copies the law. And and has a it has an incredible effect on on Brazilian mental health care. The same in Spain. In fact, when it many of the countries, Basaglia's message was often very Anti Fascist and very anti dictator. And in totalitarian countries under under dictatorships, his message had a kind of double meaning freedom in a double sense. So it had a very mixed a mixed impact in some countries, incredible in some countries. absolute fear, the psychiatric establishment kept control, and said the hospital is the way forward. In fact, we still have psychiatric hospitals, they're different. But we still have them in the UK. And they have very similar institutional logic to them.

Thea 25:42
And how is it now? I mean, could you describe it as an anti psychiatry movement that is still alive? Now? Is it? Is it a clear kind of inheritor of of his line of thought? Or, or have has there been another revolution? Since then? Is there been a backlash?

John 25:57
There's definitely been a backlash across the world against the ideas of the 70s and 80s, which were Global Ideas. You know, there's a, there's been a return to medicalization, a massive increase in the amount of sort of anti psychotic drugs given to people as opposed to therapy or talking therapy or other kinds of activities in Italy, has been a kind of double thing. And in some ways the movement has carried on. So one of the most incredible things about Italy, which, which, which needs to be transmitted is that they've also closed their criminal asylums. They didn't just close the so called medical psychiatric hospitals, they've also closed the ones where people, you know, committed serious crimes, they don't exist

Thea 26:36
I think that will be something that will flabbergast many people who, who, who are familiar with the Italian system, so I wonder if it's just worth unpacking that a little bit as well.

John 26:46
So once they closed, the psychiatric hospitals, medical ones, the ones where people go when they were so ill, which took 20 years, as I said, in some places quickly, more quickly than that, but that was the final closure, the final ones, but the end of the 90s they finally got the people out, you know, some people couldn't function the outside world, you know, it was impossible. They just literally have been institutionalised so much. But then the next stage of the movement was, well, we've got these criminal asylums, and they're, they're horrible as well. Let's get rid of them. So that's took another, if you like 20 years that Italy has no Broadmoor, it has, it has different kinds of ways of checking on people that I've done reagionaly, you know, has systems of control, but they're not psychiatric hospitals. And if you go go to Reggio Emilia, which had two asylums had a medical one and quite a small city, you see the building there, it's all abandoned. It was a criminal one. So that's an amazing thing. And people don't know about that. So the revolution in some way continued. And it continued fighting and continued deinstitutionalising. On the other hand, there was a backlash from the psychiatric establishment from the general public, quite rightly, many families said, you know, this is being dumped on us. You know, when there weren't the resources put in families felt very much that they were dealing with very distressed people, and there wasn't somewhere for them to go. And this, you know, made the Basaglia reform for many people quite unpopular. I had the experience of going around talking about my books, and many places, and I get many people enthusiastic. But I also get always get a few people come up afterwards and say, you know, it's all a disaster, don't you? And there is that division of opinion, very strong. And you know, someone like Salvini, who's a right wing politician, as I'm sure you know, in Italy has called for the return of psychiatric hospital. So it's always constant. And in Trieste, there's been a lot of controversy recently, about the removal of the last representatives, if you like, of the Basaglia revolution. Trieste is the place that many people visit to see what a Basaglian place looks like. I mean, it is quite amazing. If you go to their emergency place in the in the hospital, their emergency mental health, if you have an emergency, you go to the hospital, the General Hospital in Trieste, and it's, it's like going to a Basaglian paradise. It feels like a hotel, there's no one white coats, there's no locks, you know, it really is the Basaglian experiment, writ large. But in many other places, that's not the case and locks are returned and tying up has returned. And all that logic has returned.

Thea 29:20
You said earlier that he was he was a man of theory, but mostly of practice. The theory was obviously a necessary background to the practice, but he wanted there to be actual, actual weighs actual methods. So I'm wondering once the asylum was abolished and people were returned to be cared for in their families. Was there just thinking about the logistics here? Was there were they given clear instructions on how to deal how to cope with this? Were they were they schooled in any way were they given, you know, even just some pamphlets where they were they're very much just sort of left to figure it out.

John 29:58
You had structures that were constructed so daycare centre so decentralised. And then you have many of the patients who were removed from hospitals had flats provided for them, jobs. One of the key things of the, of which I haven't even mentioned was it were the cooperatives. So people were were reintegrated into the world of work. And that's an amazing part of the story. There's a fantastic film called Si Puo' Fare, which talks about this this experience of of all the people from the asylums, but not just from the asylums, because you've got new people with mental illness, who would have been previously put into asylums, where do they go? and they, they go towards these cooperatives, and those are still exist this network. So there were many different ways of, of kind of strategies, and the families. But when these didn't work, or when the resources weren't strong enough, or when there wasn't a commitment, then people were often dumped onto families and families weren't really given much support. In many cases, you know, and it's hard. And, you know, that is a controversial part, you know, you need, it can't be done on the cheap, it can't be done without commitment. And that commitment faded, that political commitment, people putting so much of their time into into this, which is, which is total in the 60s and 70s. You know, people are never out of the asylum, the activists, you know, really passionate, but that fades. And in the 80s. And, and so, you know, it does, there are places where mental health care is not great In Italy, there are other places where it's amazing. And as you know, re healthcare industry is regional, it's run by the region, regional governments, so you get very different care from region to region, depending on the commitment, depending on the political will, from Lombardy, to Friuli, you might get very different mental health care.

Thea 31:48
Absolutely. And I think one of the one of the criticisms, and this will be because this will be something that came because nothing was there to to fill in the gaps and to, to make sure that people didn't get swallowed up by a different system is that people who were not able to be cared for either because they didn't have families or their families weren't able to cope quite often they would end up in prison in just normal prison.

John 32:11
Yep. And that's happening today. And it's, it's certainly the case in many countries that the people who would have been interned in mental, in psychiatric hospitals are many of them are in prison, which are even worse, in terms of the way they they the training and the coping. And there were lots of people close to my heart, there are lots of people who are asked to deal with mental illness, who don't have the training for it. Universities, for example, are often seen as places where, you know, lectures are meant to be dealing with mental illness had no training in it. And there's so this kind of dumping all across society has happened. And I think that's, that's about resources, that's about commitment. And that's about structures which are failing or fading. And you know, that that's a common problem across the world. Yes, many people did end up on the streets, there were suicides, that was part of the cost of, of the revolution. And it didn't come without cost. And Bisaglia was aware of that, you know, he was very, he was he was willing to take responsibility for bad things happening, because he said this needed to be done. He was accused of manslaughter and on, you know, went to trial and was cleared, but he stood up in court and defended his practice.

Thea 33:29
I mean, yeah, that's the the enormous weight I suppose of having a law, take your name like that, for it to be known as the Basaglia Law, that's a tremendous weight to bear. I'm just wondering how he how you think he would feel about about the place, we've got to now that you know, the long haul of it all, how is it that we perceive and treatment so about how we treat and perceive and treat mental health today

John 33:54
There are numerous advances, thanks to what happened in the 60s and 70s. The stigma attached to mental health is much less than it was mental illness. There are no more psychiatric hospitals, which is not a small thing. If you go to Triest, where the psychiatric hospital was, you'll find cooperatives, you'll find a rose garden. You know that I think that is something that cannot be underestimated. But on the other hand, I think you'd be appalled at some and not surprised about the institutional logic. You know, if you build a place with five beds, if you build a place with 10 beds, 15 beds, you start to get the institutional logic of repression. It's natural to that, to that in the way the institution works. I've seen people tied up in normal hospitals for mental health reasons, and I've seen it in Italian places, and it's happening, it's coming back. And you know, it's a constant battle, and he knew that it's never completed. And he would have he would have been appalled, but also you would have been well aware that without the constant commitment to not doing that, you do it, the easier thing is to tie people up, right? It's not to stay up all night and convince them to talk to them about their problems. That's much harder. And that's what they did. But no, it's hard, it's a hard thing to do.

Thea 35:15
And presumably, he would have been ever watchful of the increasing I'm thinking, particularly in the UK now, the increasing erosion of estates involvement in in health care. As things become more and more privatised. It allows, I would think it allows a lot more of that backlash to take hold as the people running these things as businesses. And so they're thinking more about efficiencies and stuff, obviously, we can say, we would hope that that might also allow revolutionaries like himself to create completely new spaces and run them according to their own rules. More often than not, one would think it would go the other way.

John 35:53
That's right. And I mean, that's happening also in Italy, privatisation of health care, which also affects mental health, and also the drugs companies. Clearly, you know, love the fact that many people are put on medication almost immediately, and never come off it. You know, that's the perfect world Perfect, perfect for the drugs companies in there, you know, someone's gonna take this medication forever. What could be better for them? So, you know, there's that tendency to just for these, these amazing daycare centres that were set up in the 70s and 80s. You know, we're often places of creativity and an amazing kind of activities, and that's kind of dropped off a lot. And they kind of be places where you go and get your prescription, and you go home again, and the isolation has increased. And, and that, that, that, you know, how do you reverse that? It's very hard and COVID, you know, added massive, massively to that isolation for many people with mental illness. So it's a difficult situation, I think. And but there's no real sign that the psychiatric hospitals themselves will come back. And therefore we're working with a very different system in Italy. There's no, even though people like Salvini are calling for it. There's no sign. I don't think it's a concrete possibility.

Thea 37:10
It would certainly be major because it's it's there's a public that is so I think so aware of, as you said, the kind of the mythology as much as anything, the way that the story is told of this Basaglia revolution. To go back on that would be would be major, there would be so much debate, it would be it would be huge.

John 37:30
Yeah, it's not possible. And you know, those hospitals are parts of history. Now. Some of them are become museums, and some of them are become universities, and some of them are still lying, sitting there waiting for something to be done to them, they get these enormous cathedrals of mental health in the middle of cities. And, and but they're not going to be reopened and not even in modern ways, or at least not in the foreseeable future. And that isn't, that is the one of most incredible outcomes of that, of that movement. And that and then what happened in that period of the opening up and reevaluation, of mental illness, but there's always a danger of medicalization, the psychiatric establishment has reestablished itself. And universities, you know, have become much more medicalized in the way they teach psychiatry. One of the problems, the limits, I think of the Basaglia movement was it, it didn't think about forming the next generation, in universities, and schools, that allowed for a more traditional type of medical psychiatrists to come out of those places. So, you know, they couldn't do everything. But that was one of their limits, I think.

Thea 38:39
Yeah, that's very interesting is quite an oversight, I suppose. So I mean, on a final on a final question, then if we're when we're evaluating the Basaglia legacy, it's not entirely positive, there are there are clearly some negative aspects. There too, aren't there. So how should we how can we kind of remember it in a in a balanced way?

John 38:58
I think it's important to take and I do in my book, that critical approach to it. I think, in the past, many of the accounts have been sort of heroic, and hagiographican. And this is an incredible, you know, seamlessly positive. I think it added, you know, he would have said two steps forward one step back, he was well aware of the contradictions of the projects, and the problems that created and then the sort of possible problems in the future. I think, having said that, the the the Italy was so much ahead of many other countries in terms of its critical approach to the psychiatric hospital, its closure and its policies after that, and that has influenced many countries in the world, in their own process towards closure and reopening and re rethinking mental health and I think that remains an extraordinary example, for people to read about today. And I still get, I get lots of people writing to me from all over the world who have read either read my book or have heard about Basaglia, who We're, we're trying to apply that even in America in Wales. They've been applying Basaglian ideas in, in Latin America. It's fascinating how that how the examples live on and and are still debated today.

Thea 40:16
And would you say that I know I said that was my last question. But I have more. I have plenty more. Would you say that,m Would you say that Italy still is leading the way in some respects in mental health care?

John 40:27
I think some in many ways it is. But that that prime, you know, position is, is probably under threat to some extent because of what's happened recently. I mean, Trieste was a place where people would really become inspired by and it sets itself up as this model. And it was set up by the World Health Organisation also as a model of deinstitutionalization. So people from Trieste became became experts at deinstitutionalising other places. In the in the 1990s, they discovered an island, a Greek island called Leros discovered, it was kind of exposed by the press that they're designed and called Leros where they were, whether it was horrible psychiatric hospital, with patients naked, tied up beaten up in disgusting conditions, and they want, you know, this was exposed in the press, the film was made about it. And, you know, they wanted to do something about it, to close it down to reintegrate those people, and they called on the Trieste s people, you know, to come to Leros and, and, you know, they were they became this kind of action group, who would go and do this in in other countries. So I think the influence is enormous. I don't know if I have got the capability of saying it's the best mental health care in the world. I think there are, there is very good mental health care in other countries in Scandinavia, and in Holland and other places, depending where you are. But it certainly was an example that in a mixed way, had an effect on many countries in the world.

Thea 41:57
It's fascinating, fascinating talking to you, John Foot, thank you. Thank you very much for your time.

John 42:04
Thank you very much.

Thea 42:05
John Foot there. His books, "The Man Who closed the Asylums: Franco Basaglia and the revolution in mental health care", was published by Verso in 2015. And "Basaglia's international legacy from asylums to community" co edited with Tom Burns, was published in 2020. That is all for today's episode. You've been listening to the Italian files created by FILL the festival of Italian literature in London and supported by the Italian Cultural Institute in London. It was produced by Emily Naylor, more from us in two weeks time.