A forgotten revolutionary psychiatrist

The contribution of Prof Franco Basaglia in shifting care away from asylums should be recognised

Psychiatry is never short of critics, controversies and debates. The most vocal critics, such as the late Thomas Szasz, author of The Myth of Mental Illness (1961), often come from within the profession itself. Prof Franco Basaglia, the reformist Italian psychiatrist, is another figure in the history of psychiatry who belongs firmly in the critical camp, although Basaglia’s life and work differed significantly from those of Szasz and the various other critics who emerged in the latter half of the 20th century.

Despite his substantial impact in Italy and elsewhere, Basaglia’s work has been relatively neglected in English-speaking countries, partly because so few of his writings have been translated from Italian and partly because more biological ideas have dominated psychiatry in recent years. But three developments seem set to restore Basaglia to his rightful place in the history of critical psychiatry.

First, in 2015, Prof John Foot, Professor of Modern Italian History at the University of Bristol, published a fascinating book titled The Man Who Closed the Asylums: Franco Basaglia and the Revolution in Mental Health Care (Verso, 2015). Second, in 2019, Prof Tom Burns, Professor Emeritus of Social Psychiatry at the University of Oxford, wrote a superb essay in The Lancet Psychiatry (6: 19-21), titled ‘Franco Basaglia: A revolutionary reformer ignored in Anglophone psychiatry’. And, third, in the coming months, Oxford University Press will publish a new book titled Basaglia’s international legacy: From asylum to community (edited by John Foot and Tom Burns).

Against this background, it is worth re-considering the life and work of Franco Basaglia, who was born in Venice in 1924 and graduated as a doctor from the University of Padova in 1949. The young Basaglia was horrified by what he saw in the Italian asylums of the day: Indiscriminate physical restraints, grossly untherapeutic environments and routine disempowerment of patients. Always politically-minded, Basaglia set about changing conditions in the asylums where he worked and inspiring others to do the same elsewhere.

In 1964, Basaglia presented a report to the First International Congress of Social Psychiatry in London, titled ‘The Destruction of the Mental Hospital as a Place of Institutionalisation’. Four years later, L’Istituzione Negata (The Institution Denied), edited by Basaglia, appeared and had a huge impact in Italy and certain other countries, although not Ireland or the UK. Nonetheless, the book was one of Basaglia’s seminal achievements.

But perhaps the development that is most associated with Basaglia (who died in 1980) is the ‘closure’ of the Italian asylums, which was a consequence of the Italian Mental Health Act of 1978, also known as the ‘Basaglia Law’. This legislation directed the closure of all psychiatric hospitals in Italy and their replacement with community-based services, although settings for acute inpatient care were retained.

The ‘Basaglia Law’ was controversial at the time and it remains controversial today. In many senses, the debate surrounding it is very familiar: That increased liberty for the mentally ill is a huge step forward, but some of the resultant problems — homelessness, imprisonment, neglect — require more assertive solutions that have been provided to date in most jurisdictions. In Ireland, for example, we now have a situation where the rate of involuntary care is less than half of that in England, but significant numbers of mentally ill people are homeless or in prison — and both of these circumstances are especially toxic for the mentally ill.

What is most interesting about Basaglia, however, is the extent to which he brought his political sensibilities into his work as a psychiatrist. In his youth, Basaglia was an anti-fascist activist and in December 1944, he was arrested and spent six months in Santa Maria Maggiore prison in Venice.

That same spirit of resistance was clearly to the fore in his career in psychiatry too.

To explore Basaglia’s work further, especially in the context of Irish psychiatry, a meeting titled ‘The Legacy of Franco Basaglia: From Asylum to Community’ is being held at 6.30pm on Thursday 17 October 2019, at the Istituto Italiano di Cultura (Italian Cultural Institute) at 11 Fitzwilliam Square East in Dublin.

This meeting (which I’m organising) aims to familiarise attendees with Basaglia’s life and work, explore the relevance of his thought to mental healthcare today, and discuss Basaglia’s influence (if any) on Irish psychiatry. The themes of the meeting have direct relevance to anyone seeking to understand the evolution of psychiatry in Europe and beyond, and to explore pathways to the reform of mental health services today.

The October meeting will bring together international and Irish speakers to provide a trans-national exploration of Basaglia’s work, and will include both John Foot and Tom Burns, editors of the upcoming book from Oxford University Press. The meeting, which is co-organised by the Istituto Italiano di Cultura and the Section of Psychiatry of the Royal Academy of Medicine in Ireland, is accredited for two external CPD credits by the College of Psychiatrists of Ireland. Full details of the event are available on the College website www.irishpsychiatry.ie/product/the-legacy-of-franco-basaglia-from-asylum-to-community.

I look forward to seeing you there!