The Man Who Closed The Asylums

When the wind of the 1960s blew through the world of psychiatry In 1961, when Franco Basaglia arrived outside the grim walls of the Gorizia asylum, on the Italian border with Yugoslavia, it was a place of horror, a Bedlam for the mentally sick and excluded, redolent of Basaglia’s own wartime experience inside a fascist gaol. Patients were frequently restrained for long periods, and therapy was largely a matter of electric and insulin shocks. The corridors stank, and for many of the interned the doors were locked for life. This was a concentration camp, not a hospital. Basaglia, the new Director, was expected to practise all the skills of oppression in which he had been schooled, but he would have none of this. The place had to be closed down by opening it up from the inside, bringing freedom and democracy to the patients, the nurses and the psychiatrists working in that “total institution.” Inspired by the writings of authors such as Primo Levi, R.D. Laing, Erving Goffman, Michel Foucault and Frantz Fanon, and the practices of experimental therapeutic communities in the UK, Basaglia’s seminal work as a psychiatrist and campaigner in Gorizia, Parma and Trieste fed into and substantially contributed to the national and international movement of 1968. In 1978 a law was passed (the “Basaglia law”) which sanctioned the closure of the entire Italian asylum system. The first comprehensive study of this revolutionary approach to mental health care, The Man Who Closed the Asylums is a gripping account of one of the most influential movements in twentieth-century psychiatry, which helped to transform the way we see mental illness. Basaglia’s work saved countless people from a miserable existence, and his legacy persists, as an object lesson in the struggle against the brutality and ignorance that the establishment peddles to the public as common sense.

Powerful photographs of the grand exteriors and crumbling interiors of America's abandoned state mental hospitals. For more than half the nation's history, vast mental hospitals were a prominent feature of the American landscape. From the mid-nineteenth century to the early twentieth, over 250 institutions for the insane were built throughout the United States; by 1948, they housed more than a half million patients. The blueprint for these hospitals was set by Pennsylvania hospital superintendant Thomas Story Kirkbride: a central administration building flanked symmetrically by pavilions and surrounded by lavish grounds with pastoral vistas. Kirkbride and others believed that well-designed buildings and grounds, a peaceful environment, a regimen of fresh air, and places for work, exercise, and cultural activities would heal mental illness. But in the second half of the twentieth century, after the introduction of psychotropic drugs and policy shifts toward community-based care, patient populations declined dramatically, leaving many of these beautiful, massive buildings—and the patients who lived in them—neglected and abandoned. Architect and photographer Christopher Payne spent six years documenting the decay of state mental hospitals like these, visiting seventy institutions in thirty states. Through his lens we see splendid, palatial exteriors (some designed by such prominent architects as H. H. Richardson and Samuel Sloan) and crumbling interiors—chairs stacked against walls with peeling paint in a grand hallway; brightly colored toothbrushes still hanging on a rack; stacks of suitcases, never packed for the trip home. Accompanying Payne's striking and powerful photographs is an essay by Oliver Sacks (who described his own experience working at a state mental hospital in his book Awakenings). Sacks pays tribute to Payne's photographs and to the lives once lived in these places, “where one could be both mad and safe.”

A total institution is defined by Goffman as a place of residence and work where a large number of like-situated, individuals, cut off from the wider society for an appreciable period of time, together lead an enclosed, formally administered round of life. Prisons serve as a clear example, providing we appreciate that what is prison-like about prisons is found in institutions whose members have broken no laws. This volume deals with total institutions in general and, mental hospitals, in particular. The main focus is, on the world of the inmate, not the world of the staff. A chief concern is to develop a sociological version of the structure of the self. Each of the essays in this book were intended to focus on the same issue--the inmate's situation in an institutional context. Each chapter approaches the central issue from a different vantage point, each introduction drawing upon a different source in sociology and having little direct relation to the other chapters. This method of presenting material may be irksome, but it allows the reader to pursue the main theme of each paper analytically and comparatively past the point that would be allowable in chapters of an integrated book. If sociological concepts are to be treated with affection, each must be traced back to where it best applies, followed from there wherever it seems to lead, and pressed to disclose the rest of its family.

To many, asylums are a relic of a bygone era. State governments took steps between 1950 and 1990 to minimize the involuntary confinement of people in psychiatric hospitals, and many mental health facilities closed down. Yet, as Anne Parsons reveals, the asylum did not die during deinstitutionalization. Instead, it returned in the modern prison industrial complex as the government shifted to a more punitive, institutional approach to social deviance. Focusing on Pennsylvania, the state that ran one of the largest mental health systems in the country, Parsons tracks how the lack of community-based services, a fear-based politics around mental illness, and the economics of institutions meant that closing mental hospitals fed a cycle of incarceration that became an epidemic. This groundbreaking book recasts the political narrative of the late twentieth century, as Parsons charts how the politics of mass incarceration shaped the deinstitutionalization of psychiatric hospitals and mental health policy making. In doing so, she offers critical insight into how the prison took the place of the asylum in crucial ways, shaping the rise of the prison industrial complex.

Franco Basaglia (1924-1980) was an Italian psychiatrist and activist who proposed the dismantling of psychiatric hospitals and pioneered new ideas about mental health and its treatment. Basaglia was also one of the principal proponents of Italy's Law 180, which effectively closed down large mental hospitals in Italy. His ideas and his disciples have had a decisive influence in the move away from institutional care in many parts of the world, particularly in continental Europe and South America. However, Basaglia is strikingly absent from the literature in Germanic and Anglophone psychiatry. Most of the literature about Basaglia in the last 40 years has been published by his followers and supporters and has often been largely positive, with little exploration of differing responses or possible limitations of his model. Basaglia's International Legacy: From Asylum to Community provides an overview of current thinking and the international influence of Franco Basaglia. This resource draws on the combined knowledge of clinicians, policy makers, historians, and social scientists, including a handful of Basaglia's collaborators. It provides an in-depth understanding and critical analysis of the various applications of his thinking worldwide. Organised into three broad sections, chapters examine Basaglia's work and influence in Italy; in the 'Basaglian' countries of Europe and South America; and in those countries where his influence has either been rejected or significantly modified. The Editors bring together the contributions and draw out the important messages (both positive and negative) for current clinical practice and development within international mental health services.

Institutionalizing Gender analyzes the relationship between class, gender, and psychiatry in France from 1789 to 1900, an era noteworthy for the creation of the psychiatric profession, the development of a national asylum system, and the spread of bourgeois gender values. Asylum doctors in nineteenth-century France promoted the notion that manliness was synonymous with rationality, using this "fact" to pathologize non-normative behaviors and confine people who did not embody mainstream gender expectations to asylums. And yet, this gendering of rationality also had the power to upset prevailing dynamics between men and women. Jessie Hewitt argues that the ways that doctors used dominant gender values to find "cures" for madness inadvertently undermined both medical and masculine power—in large part because the performance of gender, as a pathway to health, had to be taught; it was not inherent. Institutionalizing Gender examines a series of controversies and clinical contexts where doctors' ideas about gender and class simultaneously legitimated authority and revealed unexpected opportunities for resistance. Thanks to generous funding from the Andrew W. Mellon Foundation, through The Sustainable History Monograph Pilot, the ebook editions of this book are available as Open Access volumes from Cornell Open (cornellopen.org) and other repositories.

In the late 1970s, Barbara Taylor, then an acclaimed young historian, began to suffer from severe anxiety. In the years that followed, Taylor's world contracted around her illness. Eventually, she was admitted to what had once been England's largest psychiatric institutions, the infamous Friern Mental Hospital in London

Five case studies show how different people and places were marginalized and socially excluded as the Italian nation-state was formed.