Basaglia in France

This chapter assesses Franco Basaglia’s enduring influence in France by focusing on the circulation of concepts and practices and their effects on French mental health policies and scattered experimentation. Despite similar origins, Basaglia’s early work contrasts with the Second World War movement of French psychiatric reformers to humanize the asylum, including through ‘psychothérapie institutionnelle’ and the subsequent development of a sectorization policy. The chapter then examines the extent to which Basaglia’s ideas took ground in France through the efforts of a small network of psychiatric practitioners and intellectuals, within roughly three periods: 1960–1980, 1980–2000, and 2000 to the present. In conclusion, the chapter asks what might explain the French paradox: the early receptivity to Basaglia’s politically-oriented, community-based, anti-institutional practice, on the one hand; and a tenacious hospital-centric psychiatric system and increased use of constraints and high-security confinement, on the other.

A spectre for some, a Mecca for others

In the Netherlands, Basaglia’s ideas met with great interest. His work was translated, discussed by leading psychiatrists, and, in the early 1980s, Italy became a Mecca for those who wanted to reform psychiatry. Journalists, psychiatrists, policy makers, and members of the client movement travelled to Italy to see how Basaglia’s ideology was working out. Italian democratic psychiatry inspired a radicalization of the Dutch anti-psychiatric movement. Some reformers founded Shelters for psychiatric runaways; others introduced new methods for rehabilitating chronic patients. In 1987, it was even decided, partly inspired by Italian examples, that the largest and oldest Dutch psychiatric hospital in Santpoort, near Amsterdam, would be closed. In general, however, the reduction in inpatient capacity was slow to happen in the Netherlands. The Italian experiments served as an inspiration for some, but also as a warning sign for others to avoid the ‘Italian mistake’ of changing things too radically, and too fast.

‘Visions of another world’

This chapter explores Franco Basaglia’s relation with German psychiatry, from his early infatuation with the anthropo-phenomenological tradition to the disputes with the social psychiatric movement during the 1960s and 1970s. After an overview of Basaglia’s criticism of German psychiatric schools and institutions, the chapter focuses on his personal links, most notably with progressive psychiatrists and with the anti-psychiatric movement SPK (Sozialistisches Patientenkollektiv). Finally, it analyses Basaglia’s reception, by both the medical establishment and the actors of psychiatric reform. Contrary to the current narrative of a mutual influence, the chapter argues that Basaglia can hardly be regarded as a genuine inspiration for German psychiatric reform, and was retrospectively refashioned as such.

Spain

This chapter analyses the influence of Franco Basaglia and the organization ‘Psichiatria Democrática’ on the Spanish critical movements. These movements appeared in 1971 and were organized through a clandestine group known as the ‘Psychiatric Coordinator’. This organization linked professionals (mainly young psychiatrists) who had initiated innovative experiences in various psychiatric hospitals. These developments generated conflict when opposing the norms of the dictatorship. From 1975, and especially after the approval of the 1978 Constitution, the critical movement was a force for change in mental health structures in Spain, through the established organization, the Spanish Association of Neuropsychiatry. This effort made it possible to generate the psychiatric reform in 1985 that advocated community mental health and deinstitutionalization policies. Franco Basaglia began his contacts with the Spanish critical professionals in 1970, and the relationship was maintained periodically until 1980, the year of his death.

Making sense of Basaglia

The symposium in Oxford, in September 2018, heard 18 papers from 14 countries exploring the international reception of Basaglia and the Italian reforms. In the ensuing discussions, a number of issues arose which are addressed in this chapter. There were three striking omissions in Basaglian writing—primary care, gender, and the role of specialist services. Several thorny questions kept recurring. Was Basaglia an anti-psychiatrist? Was he a Marxist? Was the movement too ideological? What was the source of resistance from North European psychiatry? What explains the North/South implementation divide in Italy? In addition, differences in understanding two key concepts were explored. What is meant by a therapeutic community? What exactly is a mental hospital? These issues are explored in this final chapter in the hope that they will stimulate further research into a richer understanding of a man and movement whose international impact is undeniable but often misunderstood.

Franco Basaglia

If history is the story of what happened, then Franco Basaglia appears to have no place in the history of psychiatry in Ireland. But if history is also the story of what did not happen, Basaglia is surely one of the seminal non-events in the history of Irish psychiatry. He is not alone. He joins the unlikely company of the Roman Catholic Church and psychoanalysis in conspicuously failing to shape Irish psychiatry to any substantial degree. The reasons are complex. The Irish asylums were profoundly social creations rather than medical ones, and deinstitutionalization, when it arrived in earnest in the 1970s, found its roots in broader social change, human rights, and pragmatism. Irish psychiatry has always been wary of abstract thought. So, while a few reforming and critical psychiatrists were influenced by Basaglian ideas, Basaglia himself remained—and remains—curiously absent from public psychiatric discourse in Ireland.

Basaglia and the British anti-psychiatrists, 1960–70

The London psychiatrists R.D. Laing, Aaron Esterson, and David Cooper were among Basaglia’s most prominent contemporaries. In 1967, they came to be grouped under the umbrella term ‘the anti-psychiatrists’, coined by Cooper. As such, in discussion they often fall under the same school of thought as Basaglia. However, this chapter highlights the fundamental differences between the British anti-psychiatric project and Basaglia’s Democratic Psychiatry, given its focus on political upheaval as well as patient care. It explores the various efforts of Laing, Cooper, and Esterson to demolish staff–patient boundaries through the Philadelphia Association Ltd, which they formed with their patients. The chapter contends that, although they shared a desire to wrest patients away from harmful institutions, Basaglia sought to do so as an ‘employee’, aiming to destroy the psychiatric institution from within, whereas his British counterparts considered themselves revolutionaries, part of an effort to overhaul society as a whole, external to psychiatry.

Has the spirit of Basaglia affected Polish psychiatry?

The anti-psychiatry movement emerged in Poland in the 1960s, demanding changes in a system based on huge psychiatric hospitals. Nevertheless, large hospitals did not vanish. Even today, they provide three quarters of the beds and serve two thirds of all patients hospitalized within the psychiatric care system. To understand better the slow pace of the Polish reforms, a theory of diffusion of innovations has been applied. Written sources such as journals, private letters, and statistical archives have been reviewed. In addition, seven non-structured interviews were carried out with mental health workers who could remember reform efforts from the 1970s. A critical opinion of the Italian reform prevailed in Poland, based on second-hand sources and rumours. These described the Italian experiences as an irresponsible reform carried out with disregard of patients’ interests. Blaming Basaglia for irresponsible reforms provided a moral legitimacy for the slow pace of reforms in Poland.

The impact in Latin America of Basaglia and Italian psychiatric reform

Latin America is one of the regions of the world where Franco Basaglia’s vision found a more fertile ground and exerted a more fruitful and lasting influence. This chapter describes the process of transformation of mental healthcare that has taken place in Latin America in the last four decades. It analyses the main factors that made it possible, and discusses how it was influenced by Basaglia’s conceptualization of the reform. It critically reviews the advances and shortcomings of mental healthcare reforms carried out in the region, taking into consideration the specific political and social context of the countries in which they have taken place, as well as the direct and indirect influences of Basaglia’s concepts and the Italian reform. Finally, it describes how the implementation of the reforms in Latin America have contributed to the development of a comprehensive approach to mental healthcare that continues to be one of the most stimulating and comprehensive approaches in global mental health at the present time.

Basaglia’s international influence

This chapter tries to answer the question of whether the thinking and the work of Franco Basaglia are widespread and influential outside Italy. In the 1970s, Basaglia had a remarkable impact both on the new Spanish psychiatry and also in Brazil where, through a series of lectures, he inspired the early stages of the Brazilian Psychiatric Reform. Since Basaglia’s premature death in 1980, his vision and thinking have continued to influence psychiatric practice and mental health reform. However, distortion of Basaglia’s thinking may be present in some psychiatric literature. The most common distortions about Basaglia can be summarized as follows: (1) Basaglia belonged to the movement of anti-psychiatry; (2) Basaglia’s approach was driven by ideology; and (3) Basaglia’s work was essentially inspired by a philanthropic impetus. All three statements are inaccurate and essentially wrong: they will be challenged by the authors of this chapter.