Psychiatry Negated: Conflict and the Culture of Resistance in Italy and Brazil
Updated: Apr 24, 2021
This is part of a series of presentations on the history of radical mental health projects called Mental Health in Crisis. Find recordings at unsoundmind.org/blog and the landing page for the series with notes, slideshows (with many more images), and info for how to follow the series at https://www.unsoundmind.org/post/mhic-presentation-series.
“It all began with a ‘no’” said Franca Ongaro Basaglia about the Democratic Psychiatry movement that, in the period between 1960 and 1980, declared war on contemporary psychiatry in Italy and would go on to close the hospitals. Who is the subject of this “no?”
The first “no” could be traced to the Venetian Franco Basaglia. He was no stranger to refusal: in 1944, at 19, the young medical student was arrested by the Nazi occupiers for writing anti-fascist graffiti with known subversives and stuck in a rank prison cell where he watched Jewish prison-mates get shipped off on trains to Auschwitz. During his thirteen years at the university psychiatric clinic, Italian psychiatry was split into two static camps that supported, in their mutual feedback loops, an unalterable complacency. There were the university clinics where researchers were well paid and respected to churn out the same old biomedical objectifications formed and formulated in a vacuum; and then there were the asylums. The asylums were crowded hells that patients, over whose lives and autonomy Italian law granted directors total control, entered into and never went out. Without any native radical tradition to draw from, Basaglia pushed back against the biomedical orthodoxy and its tendency to see the person as a mere bearer of a disease and turned to phenomenology –Minkowski and Husserl– and grounded his thinking in the concrete experiences of people. Checklists of symptoms are of little use, and a whole new set of questions arises: how does this human before me describe what they see, feel, hear, hate or love? How did they orient themselves in space, clinical, institutional, or otherwise?
The cultivation of an anachronistically empathic and sensitive approach annoyed the respectable university psychiatrists who saw Franco’s desire to know lunatics as people as the naive wish of a sincere, but hopeless, fool. So they gave him a directorship at the asylum in Gorizia, a town on the border between Italy and Yugoslavia, the limit between West and East, damning him to marginality and drudgery with few prospects and even fewer expectations beyond keeping the place barely functional. In 1961, he stepped inside an asylum for the first time and experienced an emotional revulsion in body and mind that he’d later channel into revolt against the asylum: “it took me straight back to the war and the prison. It didn’t smell of shit, but there was the symbolic smell of shit. I was convinced that that institution was completely absurd, that its function was only to pay the psychiatrists who worked there. In the face of this absurd, disgraceful logic of the asylum – we said ‘no’” (Foot, 13). Patients sat around, many nude, others chained to walls, abandoned in a space that received as much daily care as they did, which is to say it was chaotic, filthy, and ruinous. One of the nurses recalled later that “the patients were so used to seeing them as torturers that they would cower whenever they approached” (in Foot, “Photography”).
Faced with such abject suffering and destitution, the phenomenological understanding of the person falls painfully short. As Franca Ongaro Basaglia wrote: “[w]here can one trace, in this total invasion and expropriation by the institution, the distance between the ‘I’ and the 'self,’ the interval between the ‘I’ and the body necessary for the subject, if these bodies are possessed by the institution, if they are the very body of the institution?” (xiii) What, in other words, does the understanding of a concrete experience offer when one’s suffering is overdetermined by institutional violence and decay? In this space, said Franco, “neither analyses of Oedipal complexes, nor theories about our being-in-the-world have saved patients from the lethal passivity and alienation of their condition” (Psychiatry Inside Out, 64). What hope was there for sound theoretical understanding when there was no space between patient-objects and the environment they were placed in?
The typical psychiatric diagnosis facilitates and smoothens out this violent reality by flattening the complex social processes that led from a life’s assortment of problems to asylum and by tying behavior to objectified, organic causes. “The mental patient is an outcast, but in our present society, he can never oppose those who exclude him, since all his actions are circumscribed, defined and finally, dismissed, by his illness” (Franco Basaglia, Psychiatry Inside Out, 76). The Basaglias, more than any other figures in psychiatry at the time, understood the relationship between class, marginality, and madness. To them it was obvious: take a look around, they said, the asylum is full of poor people, sexual deviants, petty criminals, the disabled–in short, everyone from the margins of society. They knew, and asserted more clearly than anyone else, that the violence of the institution was only the most recent coercion in their patients’ lives. The capitalist relation that says work or die, produce or starve; the police officer who picks them up like refuse when they don’t contain their outbursts and breakdowns; and finally the psychiatrist who treats them like a disease enveloped with skin that just so happens to bear a face are stages the patients have already lived through as objects of violence before arriving at the front door of the hospital.
If there is such a thing as a “mental illness,” how could we know it under these conditions? How could we possibly objectively study it like an object when no one is free of capitalism and its violences? Capital, like nature, abhors vacuums. Therefore, it was necessary to put the psychiatric illness “in brackets,” or to suspend one’s judgement on it. They had no interest in the eternal debate over the “determinations'' of psychiatric disability, nor in pontificating on the certain reality or absolute impossibility of mental illness. Even antipsychiatric assertions that madness was the result of social processes were still operating “within the logic of positivism” since they objectified their object and viewed it as a tangible thing rather than as a dynamic process born of contradiction, of social processes or of contradictions within the body itself (Serapioni, 9).To suspend the diagnosis means to foreground the person, the violence of their immediate conditions, and the fact that madness is experienced as a public, that is, political, problem; it is an elegant way to avoid that inexhaustible vicious circle of nosological claims and counter-claims and cut straight to the task at hand: the destruction of the psychiatric hospital.
“He would either succeed in changing everything,” said Franca Ongaro Basaglia, “or else he could never accept the position of warden” (Psychiatry Inside Out, xii). At first, they proceeded much the way other radical psychiatry projects did. Mirroring especially the therapeutic community model practiced in Dingleton, Scotland by Maxwell Jones, but also Institutional Psychotherapy in France, Franco Basaglia and his team removed restraints, opened doors, threw away the straight jackets and did all the things a humanist psychiatrist was supposed to do. They paid the patients standard wages for any labor, exposing the sham that was and is “occupational therapy” as a friendly name for unpaid or subminimally compensated labor. As at Saint Alban in France, a patient club was empowered to make administrative decisions, opened a cafe, a theater, and much more, and began publishing their thoughts and criticisms openly in Il Picchio, their own independent publication. With no recourse to restraints, doctors and nurses could not sit around and relax all day, for now everyone was called to be present and solve problems creatively. Out of “no” –that first refusal to participate in acts of coercion justified as therapy– was born new ways of being in common space, of solving problems with one another.
If it is foolish to live among the mad as human beings with important things to say and valuable contributions to make, and to take this idea to its conclusion in the form of open conflict with the forces that make this impossible, then Democratic Psychiatry is foolishness armed. After three years of pushing liberalizing initiatives as far they could realistically go, the group at Gorizia announced that the therapeutic community fought for with blood, sweat, and tears there and in Scotland, England, and France was a mere starting point. At the first conference for Social Psychiatry in London in 1964, precisely when the Western world turned to community psychiatry and the therapeutic community as humanist alternatives, Franco Basaglia stated outright that the therapeutic community he and other participants had all struggled to establish were gilded cages, a more effective reinforcement of the alienating and disempowering relation inherent to the field. He immediately confronted the social psychiatrists, so fond of imagining themselves as the new humanist Pinels descending to save their patients, assembled there for the very first time with a quote from the Surrealist Manifesto about the “looney bin:” “Tomorrow morning, at visiting time, when without any lexicon you try to communicate with these men, you will be able to remember and recognise that, in comparison with them, you are superior in only one way: force” (“The Destruction,” 1). A successful therapeutic intervention “means preventing the patient from becoming conscious of being excluded, and moving from the narrow sphere of persecution by family, friends, and hospital to the global level, where he is conscious of being excluded by a society in which he is superfluous. [The therapeutic intervention] acts to soften the reaction of the excluded towards those that exclude them” (Psychiatry Inside Out, 62). Benevolence from above is productive, in the end, of the same passivity: "[the patients] sit quietly by and they wait for someone to tell them what to do next, to decide for them because they no longer know how to appeal to their own efforts, their own responsibilities, their own freedom. As long as they accept liberty as a gift from the doctor they remain submissively dominated" (Psychiatry Inside Out, 18-19). What was needed was not a more perfect model or more tender conception of mental alienation. Instead, they operated under the assumption that the tension between unequal actors engaged in concrete acts of destruction illuminated the inherent contradictions better than any model, which only served to hide them away for the comfort of social technicians.
Central to Basaglia’s vision was not just the destruction of the mental hospital, but the continuous destruction of psychiatric power, including his own. What does the name “Basaglia” represent today? More recent histories, like the one written by John Foot, have begun to repair the incredible damage done to the Democratic Psychiatry movement by the Anglophone historians who made Franco Basaglia the face of a movement they trivialize as a mere “alternative” project. Franco Basaglia was undoubtedly a kind, charismatic, and intelligent figure, but Democratic Psychiatry was not the result of any one individual. What occurred in Gorizia, and then later in Trieste, in Parma, in Cividale, Reggio Emilia, Arezzo, and elsewhere cannot be understood by reference to the name Franco. First, Basaglia is split in two: Franco and Franca. He wrote his books with his wife Franca Ongaro, and she was there every step of the way. Nothing would have happened if there was not a dedicated team of sympathetic psychiatrists, patients, and nurses involved at every step. If there is a subject, it is not Franco Basaglia and it cannot be Franco Basaglia; if it is possible to talk of Kingsley Hall as R.D. Laing’s project or the therapeutic community as Maxwell Jones’ idea, it is not remotely possible to talk about conflict in psychiatry in Italy by referring to Franco Basaglia alone. Even the books associated with this movement are collective products (most famously The Negated Institution). Unlike the major texts associated with psychiatric revolutions in France or in England, the books of this movement take the form of notes taken in the heat of battle by many hands (sympathetic colleagues, nurses, and patients alike). This was the first movement in which patients’ and nurses’ contributions were included in the major publications, on television appearances, and in public events. Democratic Psychiatry is unique in this regard, and yet we still refer to Franco Basaglia as a figurehead and symbol for the Italian situation. Why not ask instead what reverberates in the words “Gorizia,” “Parma,” or “Trieste?”
No other movement has been subject to the same level of erasure, misrepresentation, and invisibility in the anglophone world. The name “Basaglia,” if it is mentioned at all, is included as a footnote in the history of a nebulous thing called “antipsychiatry” and denounced in short order. The historians and psychiatrists would rather we forget about what happened in Italy, because, of all the groups associated with alternative and radical psychiatry in mid-twentieth century Europe, Democratic Psychiatry offered a form of therapy that was in itself a revolutionary strategy. While others talked of “socializing” currents, of personal transformation and discovery, of disalienation, Democratic Psychiatry recognized that these goals could not be reached within psychiatry treated as a separate field. Madness was inherently linked to the alienating effects of capital’s movement through the social world, which produced, by necessity, hordes of marginal figures and throwaways–a surplus treated as refuse. Only Frantz Fanon in Algeria could be said to have reached a similar limit when he resigned from the hospital Blida-Joinville and turned to non-psychiatric militancy in the anti-colonial war as a ground for healing. Democratic Psychiatry, on the other hand, discovered the means to turn psychiatric institutions into battlegrounds in the battle against social marginalization and exclusion inherent to the global capitalist order.
If psychiatry was conceptualized as an apparatus for concealing contradictions and tensions, particularly when it segregated the excluded and marginalized, the group at Gorizia would proceed by rendering power visible at all times through heightening existing contradictions and even forcing tensions where they’d already been resolved. They turned psychiatry on its head, inside out, and brought everything it wished to hide out into the open. The daily assemblies were spaces in which anyone–patients, nurses, doctors, even townspeople, volunteers, and visitors–could participate. They were completely unlike those held at liberal institutions, since the intent was not to arrive at group consensus nor to facilitate smooth lines of communication. These were “unsafe” places where unreason, protest, and incoherent expressions were heard and considered (Scheper-Hughes and Lovell, 337-8). Over time, the long-repressed and chaotic rage settled down and they became a space in which common languages were developed while new alliances and goals formed in the interstices. In fact, all the elements of the therapeutic community borrowed from England and Scotland were used in this way: patients were not encouraged to express themselves in safe, “expressive,” outlets, but to appropriate their own annihilation and destroy what was destroying them. Taking inspiration from Antonio Gramsci, no single activity or form (art therapy, patient publication, cafe, club) was viewed as sufficient in itself; alternatives were desirable because they gave patients and staff concrete alternative positions in which they can wage new battles and fight from new strategic positions in a dialectical confrontation with the wider world.
The strategy of continuous escalation in the war of position revealed the psychiatric hospital as a site in the general conflict with capitalist society itself. Each break, every destructive act, opened up a crack in the fabric of reality out of which the impossible could emerge:
When you point out contradictions you are opening up a crack. For example, when we demonstrate that psychiatric institutions only exist as an apparatus of social control, the State is forced to create something else to replace it. From the time when the contradiction first explodes into consciousness to the time when it is inevitably covered up, there is a moment, a chance for people to realize that the health system does not correspond to their needs because society itself is not organized to meet those needs. (Psychiatry Inside Out, 17)
Some cracks were more literal than others as for instance in cases when patients and staff collectively engaged in the joyous act of smashing the hospital walls or fences: Bruno Astrologhi was a patient at the time and reported that “Happiness can be defined as breaking down the walls of the madhouse with a hammer. I had blisters on my hands, but it was intensely satisfying” (in Foot). Denied responsibility and capacity under normal institutional conditions, the patient normally seeks destruction as the last desperate act at a dead end, ending in interpersonal harm or suicide. When a patient named Miklus tragically killed members of his family in Gorizia, a painful silence overcame the normally boisterous assembly. Was the project a failure? Franca Ongaro reflected on the sense of doom and anxiety that prevailed in the wake: “every patient felt responsible, guilty of that which M. had done. Alongside the nurses and doctors the patients identified with a gesture which seemed to signal the failure of everything we had hoped to achieve” (in Foot). In a text released prior to this incident, Franco Basaglia wrote that acts such as these are not a result of “a lack of supervision, but rather an indication of the institution’s lack of support” (Psychiatry Inside Out, 90). After 15 days of anxious silence, a patient finally spoke up and asked why they couldn’t talk about the “terrible thing” for which they were all responsible (Lovell and Scheper Hughes, “Lessons,” 338). Destroying the institution can be seen in light of normally tragic conclusions as an appropriation of accumulated negativity in a concrete seizure of withheld liberty.
These acts became communal rituals knowingly and intentionally presented to the media as scandals and opportunities to create local tensions by exposing the public to the carceral realities of psychiatric hospitals. Artists, filmmakers, photographers, musicians, and theater groups were all invited over the years to bear witness, to spread the word–all in the service of intentionally producing an anti-institutional culture in the public consciousness and to curry favor with sympathetic locals in areas where fascist politics still captured the imagination of some hospital employees and politicians. In 1968, Carla Cerati and Gianni Berengo Gardin were invited by the Gorizian group to produce a series of photographs, which were published in 69 with the title “Dying Because of Class: The Condition of Asylums” accompanied by a number of essays by the Basaglias, Frantz Fanon, and Primo Levi. That same year, 10 million Italians watched Sergio Zavoli’s “The Gardens of Abel,” and were exposed, many for the first time, to the voices of patients talking about their experience of institutionalization and the changes taking place. Among them, Carla Nardini was interviewed in the gardens. Identified as “Carla” in the film, Nardini was an Auschwitz survivor who described being beaten and shocked prior to the arrival of the Democratic Psychiatry circle. She was asked what had changed since their arrival, she responded “everything” (Foot, “Television”). Democratic Psychiatry repeatedly broke the unspoken yet sacred agreement kept between madhouse keepers and that nebulous entity “the public” to keep the mad contained: “come and see,” they said, referring to both the horrid conditions of the place but also their project of negation.
By 1968, at the height of their own success as a therapeutic community, the Basaglias and a number of their colleagues concluded that they’d reached the limit of possible conflict in Gorizia and left for new ventures in Parma, Arezzo, Cividale, and Perugia. Unified in general strategy, each location of the Gorizian diaspora (as John Foot calls it) was marked by varying emphases and theoretical divergences. In Cividale, Giorgio Antonucci and Edelweiss Cotti subscribed to an antipsychiatric position that closely resembled Thomas Szasz’ in the US, which categorically denied the existence of mental illness and rejected all language perceived to be psychiatric. There, they occupied a hospital for three days and generally moved much faster to shut down existing services than the Gorizian group. Challenges arose in Parma to shut down not just the asylum, but nursing homes, special schools, and all segregative institutions. The group in Perugia moved to make their operations more public and set up community centers to replace the hospital. In Reggio Emilia, Giovanni Jervis (one of the major intellectuals of the movement) and others placed the emphasis on preventing people from entering the hospital at all; their strategy consisted in finding potential patients early and setting them up with supports to avoid possible institutionalization in the first place. A wide range of tactics–occupations, mass visitations to hospitals, professional walk-outs, patient worker and professional strikes– were developed and borrowed from place to place around the country. And not only internally in the fight against asylums. During the Italian Hot Autumn marked by strike waves and student participation in radical struggle in 1968-9, cross-pollination was frequent and encouraged, with many student radicals becoming volunteers and participants in the anti-asylums struggle while tactics and theories were developed in conversation. As Franco Basaglia put it speaking to an audience in Brazil in 1979, “[w]hen we say no to the asylum, we say no to the misery of the world and we join all the people in the world fighting for a situation of emancipation. Right now, we are not just a psychodrama society, nor a social psychiatry society. We are united people struggling for a real freedom in the world” (in de Almeida, 96). Democratic Psychiatry was resolutely and centrally political in character: strikes, occupations, riots, and anti-colonial wars around the world were conceived of as part of the same general tendency to develop new communal forms through concrete struggle within and against the existing social fabric.
The movement entered a new phase in the early 1970s when the therapeutic community was declared, for all intents and purposes, dead weight and a new justification for institutionalization and rationalization of subtle domination. In 1972, the last remaining group in Gorizia, fed up with the remaining vestiges of unchanging institutional life, penned a collective letter of refusal to continue to hold a “useless” and even “damaging” presence, taking direct inspiration from Frantz Fanon’s famous “Letter to a Resident Minister.” They no longer found it acceptable to answer the patient’s question "’When can I go home?,’ with the lie, ‘tomorrow,’ knowing full well that for you tomorrow would never come” (Psychiatry Inside Out, 166). It was around this time that the Basaglias moved from Colorno to Trieste where they acted more decisively and aggressively in the struggle to close asylums. In just six years time, in a whirlwind of excitement and activity, they closed the asylum for good. Even more than Gorizia, the asylum in Trieste rapidly became a site of pilgrimage and projects for artists, student activists, leftist militants, and sympathetic professionals. A number of co-operatives were formed, many of them highly unconventional like the pirate radio station Radio Fragola or the theater troupes that offered new means for patient communication with the surrounding community and beyond. While being destroyed, the halls of the hospital were opened up to new possibilities: a ward became an exhibition hall, a theater, a cafe, bar, or a conference center. The site of confrontation would no longer be primarily the privileged internal conflict between the psychiatrist, the nurse, and the patient within the hospital; increasingly all that was hidden within its walls erupted explosively into the public and was brought to bear on a society hitherto unable to face it. The walls and fences were torn down, as was the general modus operandi, but, more than before, mad parades took to the streets to demand inclusion in the public life of the city. While these events were real, concrete acts, they consciously worked in a highly symbolic dimension. The most famous incident included hiring an artist to help create a large, blue horse of paper mache named Marco Cavallo. Marco was named for an old laundry horse, which for many years was the only thing able to come and go from the hospital. Upon each paper sheet on Cavallo’s body was written the dreams of patients symbolically seizing fugitive freedom outside the walls. Once the media arrived, it was “discovered” that he couldn’t fit through the gate to get out, so they were forced to smash the wall down to make way for the joyous parade.
Around this time, the words “freedom is therapeutic'' were scrawled on a wall in Trieste. They took this idea as far as possible, rushing ahead towards the next confrontation and breaking through the next threshold everytime it would’ve been easy to stop and walk away satisfied with the progress made. Slogans such as these further highlight the general thrust of Democratic Psychiatry: maximizing the political dimension of the struggle around the meaning and treatment of madness and minimizing the medical to a mere factor. In 1977, Franco Basaglia held a public press conference in which he declared that San Giovanni Hospital was closed even though patients still lived there, in order to create more tension and speed up the process. Participants in the anti-asylum movement generally did not lose sight of the fact that to release asylum inmates back into the community was in a sense a violation of the unspoken rules of that community and was experienced as a violent crisis.
This in turn provoked a crisis in labor, which played out first in the factories of Parma where the ex-plumber Mario Tommasimi strove to integrate ex-patients and the developmentally disabled into union labor. In Trieste, the production of various co-operatives diversified the options for incorporation, though, unlike in the United States where such integration is the end point for many progressive organizations, this was consciously perceived as a stepping stone to transfer patients and the disabled from the enforced poverty and marginalization of mental health services to the enforced poverty and marginalization of capital. On the same day Marco Cavallo was rolled out into the streets, the nurses in Trieste went on strike decrying the starvation wages of the institution and the poverty awaiting patients upon release (Lovell and Scheper Hughes, 341). The collapse of institutional barriers and mechanisms of segregation opened new opportunities for collaboration and solidarity while the lived experience of emancipation infused participants with the desire for freedom, but there were no illusions that this was anything but a first step towards the next struggle, the next instigation of crisis. Coordinated strikes by patients, students, and nurses against institutional conditions, asylum construction, work conditions, and sheltered workshop options from the late 60s through the 70s is testament to a general awareness of the connection of labor to the anti-institutional movement.
In May 1978, with the support of the Christian Democrats and Communists, the Basaglias helped draft the Law 180, often misnamed the “Basaglia Law,” which made psychiatric patients into medical patients like any other, erased speculative nebulisms like “dangerousness,” barred any new entries into Italy’s psychiatric hospitals, and set a concrete date for the closure of those that still stood. Despite its enormous consequences, this was considered by many in the movement to be a compromise, since, for instance, it still contained a provision that allowed for up to 15 days of involuntary commitment in a general hospital. Nor did it guarantee the kind of social and political integration that happened in Trieste, itself the result of protracted and dedicated struggle: there are no ready-made answers or forms conforming to “practices capable of sustaining the freedom of those in a moment of fragility” (Salvini, “Caring”). By the early 1980s, the hospital San Giovanni in Trieste was effectively closed, with just a few patients staying in apartments on the grounds. Everyone else had either returned home or been placed in apartments or small homes where a stay was not contingent upon a medical diagnosis. The hospital had truly been destroyed, and, out of its wreckage, over 40 health centers emerged in which a new ecology of care networks flourished where former patients or new “guests'' could make affective investments in meaningful, and frequently political, projects. The question was always “how to destroy to invent,” how to plant new growth in the wreckage of built-up violence centuries old, how to get out into the world and find one’s place in it. All these dramatic and romantic overturnings, in other words, were not the end of a single protracted battle but the very beginning of a thousand new chapters in mental health care.
In some ways, the deinstitutionalization in Italy unfolded in an almost diametrically opposite manner to that of the United States, even where so-called “community mental health centers” were established. Where the Italians emphasized dignity and responsibility in the commons, the US boasted of individual negative rights and consumer choices in treatments or budget slashing corners cut; where the Italian groups exposed the class war, misogyny, and racial animus underlying psychiatric diagnosis and subsequent segregation and marginalization, the US discovered ever more subtle and minute forms of micro-deviancy to be intimately managed by technical experts spreading marginalization and isolation into the remotest corners of the country; where Democratic Psychiatry sought to form new bonds and common languages in struggles that limited and negated their own institutional power, US-based professionals got lost under the detritus of obscurantist titles, mystifying specializations, and meaningless “studies” that only led to more studies. The lesson of Trieste is that extra-hospital therapeutics is not an arithmetical matter of continually adding psychiatric teams or buildings into a city whose fundamental structure breeds alienating relations–in this case, the “[o]ld segregational structured are simply miniaturized and [...] internalized” (Guattari in Amarante and Torre, 1098). Rather, it is a matter of concrete acts of destruction and reconstruction of space itself, the seizure of new territories where new social forms can take root. Year after year, progressive professionals in the US mortify their bodies and psyches going round in circles in a kind of purgatory hoping only to come across a new model or training to apply. The best they can hope for in our current predicament is a guided cage for two where the patient’s basic needs are met, but they remain without autonomy, love, sex, and happiness while the professional suffers in overwork and terrible conditions but content at least to have guaranteed the other’s continued existence in incrementally improved circumstances.
If we want to see a real torchbearer of this revolutionary method, we should turn to the Brazilian anti-asylum movement. What, if anything, was imported into Brazil? Certainly not a model. When the name “Basaglia” is sung in joyous anthems in the streets of Belo Horizonte, it refers not to a man, but above all to a “detonation of a situation” (“The Optimism of Practice,” 114). A patient participant of the annual anti-asylum parades held in Brazil every year on May 18 introduces a whole humorous Basaglian vocabulary: “Basaglia: the guy who frees the looneys. Basaglía: to become like Basaglia. Basaglismo: Basaglian lifestyle. [...] Basagliaismo: Study of the Basaglian effect” (ibid, 123). In the 1970s, Brazil was undergoing massive, rapid transformation as it faced new opposition to over a decade of autocracy and its repressions from pro-democracy tendencies and the explosion of new subject groups demanding recognition and power–feminism, gay liberation, black consciousness, indigenous sovereignty. The anti-asylum movement arose out of this same period of political rejuvenation and experimentation with subjectivity and has embodied the strategy of conflict plus culture or conflict as enculturation and culture as means of conflict typical of the Italian movement.
Despite some humanizing initiatives in the 40s and 50s, like the art therapy practice of Nise da Silveira discussed in the last session, Brazilian psychiatry, with some of the most relaxed commitment standards in the world, had regressed under the dictatorship to a blunt carceral mechanism of social control and state-sponsored violence against marginal figures. The symbol of the state’s organized annihilation of the mad was the Hospital Colônia at Barbacena. Established in 1903, the hospital was a veritable dumping ground for undesirables of all sorts, though as was common in this country so heavily marked by the race science known as eugenics, a significant number of the inmates were afro-Brazilian. Only in recent years has the extent of the horror of this place become more widely known; it is now thought that at least 60,000 patients died there –averaging around 16 a day– as a result of medical experimentation, neglect, malnutricion, torture, murder and sickness. The excess in human bodies led to an active trade in corpses for universities, and the rest were dissolved in acid (see: Deniz; Venturini, Goulart, and Amarante). Under the motto “work conquers all,” patients were forced to work, often naked, all day in what was named “The City of Fools.” The runaways had the best chance of survival.
The Mental Health Worker’s Movement (MTSM) formed in 1978 to draw attention to the extreme situation of Brazil’s hospitals. In April of 1978, a coordinated strike followed a wave of protests resulting in the firing of many of these partisan workers. In 1978-9, with the invitation of local partisans, Franco Basaglia did a whirlwind tour around Brazil –his second visit after one in 1969– giving 14 speeches in 10 days around the country, collected later in a volume called “Brazilian Conferences” (currently not translated into English). With Law 180 so recently passed, some participants in the conferences looked to Basaglia for leadership in the international struggle, asking him what was to be done. But he “refused to play the part of a lecturer who comes from abroad to tell stories and give technical advice” reflecting later that “I have become famous because I ‘opened up’ a psychiatric hospital and the press described me as the ‘man who freed the mad’ [...] I have become a star for the bourgeois world – with lots of invitations from students, Social-Democrats, Communists, everyone … because everyone wants to know what to do, what can be done … and this is another way of destroying an experience. I think that today, I have become an institution” (in Foot, 388). In order to hold onto the “Basaglian effect,” we must actively destroy the myth of Basaglia the liberator, something I am confident he himself would support given that he did more to combat that aura of heroism that surrounded his person than did other major figures of radical psychiatry like R.D. Laing or Thomas Szasz. At one of the major conferences, Félix Guattari, Thomas Szasz, Erving Goffman, Gilles Deleuze, and Robert Castel all attended along with Basaglia, but only the latter stepped down from the podium to meet with the local MTSM militants to discuss concrete strategies for closing the asylums (although Guattari and Castel also made links with other militants on the ground [See: Amarante and Nunes, 2068 and Venturini et al., 116]).
This led to visits at local asylums and more meetings with local militants to raise awareness of their fight. After visiting the hospital at Barbacena with local journalists, students, and anti-asylum partisans, he publicly drew comparisons to a Nazi concentration camp, a common rhetorical analogy in anti-institutional struggles around the world, especially for the generation who survived concentration camps only to discover painful similarities in their own institutions or even met survivors of the camps in cramped hospital quarters. Soon after, the filmmaker Helvécio Ratton finished producing a documentary on the ground at Barbacena entitled In the Name of Reason that lingered on the sense of degradation and brutality, explicitly framed by quotes from The Negated Institution. Despite efforts by the Brazilian government to block its screening, the film was shown to thousands; at the same time, a report by Hiram Firmino called In the Dungeons of Madness about Barbacena was published in the Diário de Minas newspaper. Capitalizing on the excitement generated by these conferences, public outrage, and cultural events, the MTSM and friends organized a series of congresses and conferences in the late 1970s and 1980s to continue making connections and keep up the pressure. In 1986, at a meeting held in Buenos Aires, the Network of Alternatives to Psychiatry proposed a collective motto, “for a society without asylums,” a motto that included anyone– patients, inmates, and workers alike–opposed to the carceral logic of the institution. In 1987, this morphed into the group moniker under which anti-asylum partisans worked: “Movement for the Struggle Against Asylums” (Movimento da Luta Antimanicomial, or MLA).
Creating a public culture of contestation continued to be a central part of their strategy. Much of these cultural productions centered around the question: what is the place of madness? Where is it excluded and marginalized and where it is welcomed? The designation of May 18th as the “Day of Struggle Against Psychiatric Hospitals” on the tenth anniversary of Law 180 in major cities around the country complete with protests of exclusion and psychiatric violence, but also parades to celebrate the movement and its successes, is one way of bringing this question out into the public arena. In line with this cultural tradition, Brazil is today host to an exceptionally rich body of musical groups (ex: Harmonia Enlouquece, Trem Tan Tan, Os Impacientes), films (ex: Brainstorm), theater groups (ex: Ueinzz Theatre Company), and carnival groups (ex: Loucura Suburbana, Tá Pirando Pirado Pirou) that explore the social realities and complexities of madness and the response to it, many of them take the form of boisterous celebrations of difference led by mad people or patients themselves (Amarante and Nunes, 2071). In the late 1980s, in the midst of their cultural explosion, following, I should add, extreme censorship and repression from the anti-communist military regime, Brazil introduced one of the most far-reaching public health policies in the world, the SUS, the Sistema Únio de Saúde, or the Unified Health System in English (Gabriel Figueiredo in Mad Marginal, 165). The new organizational forms corresponding to this deep questioning and continuous public contestation crystallized under the name CAPS (Centro de Atenção Psicossocial) or Psychosocial Care Centers in the early 1990s. Taking inspiration from the model developed in Trieste, the CAPS were designed to replace hospitalization and the ambulatory model responses in use in Brazil’s largely private psychiatric facilities by integrating patients into a sustaining network by addressing immediate needs like housing or food but also deeper dimensions of life like cultural participation and the desire for satisfactory leisure activities. The CAPS were greatly expanded with the passing of Law 10.216 in April 2001, which also spelled out concrete legal rights for mental health service users (Venturini et al., 124). The CAPS have grown from just a few hundred spaces to over 2,000 in the aughts, while the number of long-term hospital beds has dropped from 100,000 to just 30,000 (Amarante and Torre, 1104).
In 1990, representatives in the field of mental health from a number of countries in Latin America, including Brazil, met in Caracas, Venezuela for the Regional Conference for the Restructuring of Mental Health Care. Participants declared their intent to move from hospital care to community care with a unified stance against the perpetuation of violence. Given that the Latin American resistance movements were from the outset internationalist in character, a principle of openness and sharing of knowledge and resources was central to the agreement. International correspondence between the Italian and Brazilian movements continued after Franco Basaglia’s death in 1980, as did activities at Trieste, which were then directed by Franco Rotelli. Laws such as those passed in Italy and Brazil are the fragile compromises of the state with large, widespread anti-institutional struggles; thus, they are constantly under threat. Through the 1980s and 90s, Franca Ongaro Basaglia became Law 180s most fierce defender against reactionary backlash from the political right and center and the old guard in psychiatry. Brazil’s gains are today under extreme strain under Jair Bolsonaro’s regime and the turn to the right. In 2019, he “criticized the current ‘ideology’ of the system and proposed to replace it with ‘scientific methods’ based on the ‘technical knowledge’ of psychiatric hospitals, biological treatments such as electroconvulsive therapy, and the hospitalization of children and adolescents” (Miguel, 263). With Bolsonaro, Brazil has also seen the return of fierce anti-communist state discourse that sees all “others” –all the gays, feminists, leftists, etc– as pathological deviants in need of treatment. Studies of hospitals under his regime have reported drops in environmental conditions and increases in incidents of torture (Ibid, 263).
Our situation looks dire, and yet, in 1961, no one would have thought that the asylums were going anywhere. By 1978, the destructive delirium was unstoppable and international. In Trieste and Barbacena, the stone fortresses of reason fell at the hands of “loonies” and militants who “demonstrated that the impossible can become possible” (F. Basaglia in Serpioni, 10). There is still much to destroy–many asylums both literal and figurative standing haughtily in our path– in the ludicrous war to replace the apocalypticism of the present with the impossibilities we desperately need.
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