Trieste, or what lay behind the walls

“Freedom is therapeutic” was the title of the article and of the first issue of Perspectivas Sistémicas, in that year 1988. In that article I developed a critical — and also admiring — account of the Italian model of psychiatric deinstitutionalisation, whose evolution came out of the Trieste experience led by the psychiatrist Franco Basaglia. I had just returned from Italy, where I had coordinated the model’s group of volunteers in Trieste, in which we worked — without pinning that label on it — in a systemic way.

Social networks were woven together in that experience: the interdisciplinary work of physicians, social workers, nurses, psychologists, artists, and of many other professions that are not conventionally associated with work with madness. Various institutions — governmental, municipal, private, educational as well as catering or welfare institutions, among others — sought to join their efforts in order to put into practice an ideology of leaving the asylum behind. Therapeutic sessions, with or without the frame of reference of the consulting room, could take place in squares, in cafés, in the course of walks along the shore of the Adriatic.

Workshops of theatre, sewing, sculpture, painting and cooking, a hairdressing salon, a restaurant and a café, a mental health centre, a nursery school and a large park stand behind the walls of the former San Giovanni asylum, in the centre of Trieste. Walls that are still kept, as proof that there was once an asylum there. An idea that today has to be explained to the new generations of children and adolescents as a myth or an ancient legend. Walls to which Basaglia alluded when he said that the walls of segregation rose in society in three places: prisons, asylums and cemeteries.

Years later, in this year 2007, the experience continues. Contested, criticised, perhaps hindered to a greater degree, since it was supported at its beginnings by the parties of the left and since today the resurgence of right-wing groups in Europe undermines the institutional rupture, by setting out to rehabilitate the total, hierarchical and pyramidal institutions which, in Italy, had condemned the psychiatric patient to ostracism. The fact remains that the permanent questioning of functions was one of the movement’s original bastions: this critique of the development of the role keeps its limits from becoming rigid and makes plasticity part of the dynamics of the model.

From Gorizia to Trieste: the axes of the process

What constituted, in a nascent but energetic way, the first deinstitutionalisation in the city of Gorizia in 1961 — a successful process, but one aborted by Basaglia’s removal from his post as director — was followed, ten years later, by his accession to the same post, but in the city-province of Trieste, where the ideologue attempted to develop the same methodology.

Influenced by the precedents of the French May 1968, by the workers’ movements in Italy, by the parties of the Italian left, by the experiences of English antipsychiatry carried by Ronald Laing and David Cooper, by the concepts of Maxwell Jones’s Therapeutic Community, by the conceptualisations of the Frenchmen Félix Guattari and Robert Castel, among others, Basaglia essentially centred the process of deinstitutionalisation on a series of points. First the social reintegration of the hospitalised patient, sometimes in flats shared with other patients, sometimes in his family, sometimes on his own; the elimination of every coercive method, such as punitive medication, insulin therapy or electroshock (and this method was created by Cerletti and Bini in that same Italy); the restitution of the civil and human rights of the mental patient; the way out of the asylum, that is to say the abolition of the asylums in Italy and the ban on building new places of psychiatric confinement; health benefits that were decent and consistent with the socio-economic reality of the patients who had left the institution: such were the central components of the process.

A process which, from concrete praxis, led to the framing of law 180 which, as a national law, gave the Italian State some twenty-five years to do away entirely with the asylum system — which shows an interesting evolution: whereas most laws give a certain dose of order and lay down rules for social organisation, partially or totally, this particular law comes to give a legal framework to what was already developing in the provinces of northern Italy. It comes from regional practice supported by theory, and it goes towards general practice supported by law.

As can readily be seen, the abolition of the asylum is only one part of the process. Here, in Argentina, deinstitutionalisation and leaving the asylum behind have been taken to be one and the same. To deinstitutionalise is far more than abolishing the psychiatric hospital: it entails dismantling the oppressive hierarchical pyramid that brings all its weight to bear on the last link of its chain, the mentally ill person; and for that, the master builder of the movement relied on all the points described in order to carry out the process. Unfortunately, Basaglia died in the middle of the process. He died — as Miguel Mofatt would note in an interview with the Argentine daily Página 12 (1987) — of a tumour in the organ he defended most in his life: the brain. His genius has nonetheless endured over the years, for it is the legacy that makes men immortal.

Palazzo, ten years on

The image of the outcome of the asylum institution made itself pathetically present when I came back to Buenos Aires with the Trieste group for an Alternatives to Psychiatry congress (1986), attended by various international and national figures from experiences of deinstitutionalisation and antipsychiatry; some of those experiences were pieces of work carried out inside the asylums themselves, thanks to the creativity, the initiative and the daring of certain professionals who, in the time of the “dirty war”, had been branded subversives.

I had done my first placements, in my second year at university, in a former ward of the Borda hospital that took in children and adolescents. There was Palazzo^**, a boy of thirteen who, his head shaved and an empty glass bottle in his hand, wandered through the ward and the corridors of the asylum asking for money to buy himself a Coca-Cola. This friendly and affectionate child carried off the tenderness of almost all the professionals. More than once, and as a rule, he would take us by surprise, sitting on the floor, tugging at our trousers to signal his presence and to claim the obligatory coin.

At the end of that year 1986, I arrived with the Italian delegation at the Borda hospital and we were waiting in the central hall to go in to one of the presentations of the congress being held there. We were distracted and lively, in the middle of a conversation, when I felt someone tugging at my trousers. I looked down and, suddenly, ten years after my time at the asylum, I found myself face to face with Palazzo. I stood petrified as I looked at him, and in that dialectic of gazes I could still make out that forlorn child who used to roam the old ward. To be sure, the boy of those days was now a man with a shaved head; he had exchanged the Coca-Cola bottle for a blackened kettle and an empty maté gourd, and he was asking for money to buy yerba maté. He was still sitting on the floor, but with an almost crawling attitude. I had great difficulty coming out of the stupor into which that situation had plunged me. For here was the living and representative image of the institutionalising and segregating effects of the asylum: ten years on, Palazzo was still in the same state, he had only exchanged the soda for the kettle and the maté.

Nineteen years after that first article and that first issue of Perspectivas Sistémicas, the state of the asylums in Argentina has changed little. With the exception of the Río Negro experience, no substantial change, and still less a deinstitutionalising one, has been carried out in most of them. A few aesthetic, cosmetic alterations, but nothing on the side of ideology or of practices tinged with horizontal attitudes and social reintegration. Many professionals work in isolation in favour of a more humanising and anti-segregationist treatment, but within the institutional context they are devoured by the systematisation of the institution.

Systemic practitioners in this institutional game

And in this institutional game of mental patients, we too are involved, we systemic practitioners. Perhaps — and this is no doubt the main reason — because the systemic and cybernetic model applied to the human sciences was born with psychosis, and from there took shape as the ideological and theoretical genesis of the antipsychiatric and deinstitutionalising groups. That early research mounted by Bateson’s group, without denying other theories, attempted to answer the phenomenon of schizophrenia by observing what they called the “double bind”, mainly between the mother and the psychotic member. “Toward a theory of schizophrenia” (1962) was the first article to synthesise these findings, and it served as a support for the brilliant English psychiatrist Ronald Laing, together with David Cooper, to give body to the antipsychiatric movement.

The theory clearly decentralised the leading role of the mental patient and made family dynamics responsible for his bizarre behaviour. Why then should only the identified patient be hospitalised? To that question, antipsychiatry and the Basaglian team, among others, answered with alternative and deinstitutionalising actions; and here at home it was D^r Mario Tisminetzky² who, at the La Matanza hospital, came to hospitalise the whole family.

The evolution of the systemic field

During that time, from the appearance of Perspectivas Sistémicas until today, systemic practitioners have begun to correct certain terms that were generating confusion. First, they stopped quarrelling with psychoanalysts and disparaging them out of self-defence; that is to say, they began to build an identity of their own. They no longer needed, as at the beginning, to “be by differentiating themselves from”, even though they had to elbow out a place for themselves, faced with a clear primacy of psychoanalysis as the only valid and ethical model of psychotherapy. For their part, the psychoanalysts, disqualifying at the outset, have become more respectful of the practice of other therapeutic models, even if the mistake is still repeated of confusing psychoanalysis, or the fact of being psychoanalysed, with psychotherapy, and the analyst with the psychotherapist.