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Democratic Psychiatry/Psichiatria Democratica

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Introduction
Publications
Research and Practice
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Introduction

Democratic Psychiatry (Italian: Psichiatria Democratica) is an Italian society and movement for liberation of the ill from segregation in mental hospitals by pushing for the Italian psychiatric reform. The movement was political in nature but not antipsychiatric in the sense in which this term is used in the Anglo-Saxon world. Democratic Psychiatry called for radical changes in the practice and theory of psychiatry and strongly attacked the way society managed mental illness. The movement was essential in the birth of the reform law of 1978.
Democratic Psychiatry was created by a group of left-orientated psychiatrists, sociologists and social workers under direction of Franco Basaglia who was its figurehead. An organizing committee, which constituted in Bologna the first nucleus group called Democratic Psychiatry, consisted of Franca Basaglia, Franco Basaglia, Domenico Casagrande, Franco di Cecco, Tullio Fragiacomo, Vieri Marzi, Gian Franco Minguzzi, Piera Piatti, Agostino Pirella, Michele Risso, Lucio Schittar, Antonio Slavich.
In 1977, Democratic Psychiatry helped the Radical Party, a political organization principally concerned with the human rights defense, to collect together three-quarter of a million signatories to a petition to improve the mental health law and thus to prohibit hospitalization to psychiatric hospitals. According to Italian law this petition could have resulted in a national referendum on the issue. To avoid a referendum which could have forced the government to resign, the government passed Law 180 in May 1978 and thus initiated the dismantling of the psychiatric hospitals.
The 2010 National Congress of Democratic Psychiatry in Romе elected the new directive committee consisted of national secretary Emilio Lupo, national president Luigi Attenasio, honorary president Agostino Pirella, national treasurer Maurizio Caiazzo.
Basaglia and his followers deemed that psychiatry was used as the provider of scientific support for social control to the existing establishment. The ensuing standards of deviance and normality brought about repressive views of discrete social groups.This approach was nonmedical and pointed out the role of mental hospitals in the control and medicalization of deviant behaviors and social problems. According to A. Giannelli, at least in the beginning Democratic Psychiatry used phenomenological and existential ideas as its ideological and cultural reference point. However, according to P. Fusar-Poli with coauthors, Democratic Psychiatry was culturally grounded on Gramsci’s theory of “revolutionary reform” and Foucault’s critique of the “medical model”.
The objectives of the association were (and still are) to pool professional initiatives and energies in any part of society which are aimed at closing mental hospitals and restoring the rights of psychiatric patients.
Basaglia Law
The Basaglia Law or Law 180 (Italian: Legge Basaglia, Legge 180) is the Italian Mental Health Act of 1978 which signified a large reform of the psychiatric system in Italy, contained directives for the closing down of all psychiatric hospitalsand led to their gradual replacement with a whole range of community-based services, including settings for acute in-patient care. The Basaglia Law is the basis of Italian mental health legislation. The principal proponent of Law 180 and its architect was Italian psychiatrist Franco Basaglia. Therefore, Law 180 is known as the “Basaglia Law” from the name of its promoter. The Parliament of Italy enacted Law 180 on May 13, 1978, and thereby initiated the gradual dismantling of psychiatric hospitals. Implementation of the psychiatric reform law was accomplished in 1998 which marked the very end of the state psychiatric hospital system in Italy. The Law has had worldwide impact as other counties took up widely the Italian model. It was Democratic Psychiatry which was essential in the birth of the reform law of 1978.
Psychiatric reform in Italy
Psychiatric reform in Italy Psychiatric reform in Italy is the reform of psychiatry which started in Italy after the passing of Basaglia Law in 1978 and terminated with the very end of the Italian state mental hospital system in 1998. Among European countries, Italy was the first to publicly declare its repugnance for a mental health care system which led to social exclusion and segregation. The reform was directed towards the gradual dismantling of the psychiatric hospitals and required a comprehensive, integrated and responsible community mental health service. The object of community care is to reverse the long-accepted practice of isolating the mental ill in large institutions, to promote their integration in the community offering them a milieu which is socially stimulating, while avoiding subjecting them to too intense social pressures.

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Publications (date ordered)

Asylum An International Magazine for Democratic Psychiatry Asylum. The magazine is a forum for free debate, open to anyone with an interest in psychiatry or mental health. They especially welcome contributions from service users or ex-users (or survivors), carers, and frontline psychiatric or mental health workers (anonymously, if you wish). The magazine is not-for-profit and run by a collective of unpaid volunteers. Asylum Collective is open to anyone who wants to help produce and develop the magazine, working in a spirit of equality. 

 

 

 

Liberatory Psychiatry, Philosophy, Politics and Mental Health EDITORS:Carl I. Cohen and Sami Timimi, Cambridge University Press, 2008
Psychiatry can help free persons from social, physical and psychological oppression, and it can assist persons to lead free self-directed lives. And, because social realities impact on mental well-being, psychiatry has a critical role to play in social struggles that further liberation. These are the basic foundations of liberatory psychiatry. In recent years, dramatic transformations in social and political structures worldwide have increased the problems of domination, alienation, consumerism, class, gender, religion, race and ethnicity. Confronting the psychological impact of these changes, and exploring new ideas to help develop the liberatory potential of psychiatry, this book should be read by mental health practitioners from the widest range of disciplines and those interested in social theory and political science

Defines a new role for psychiatry
Sets an agenda embracing social and political factors
International in outlook and holistic in coverage

Psychiatric Reform in Italy Dr. Giovanna Del Giudice, Mental Health Department, Trieste 1998 The process for the reform of public psychiatric assistance which has taken place in Italy over the last 30 years has resulted in the transition from an asylum psychiatry based on exclusion and internment to a community mental health work-style based on inclusion and the restoration and construction of rights for persons affected with mental disorders. The transition from the psychiatric law of 1904 - which defined the mentally ill person as “a danger to himself and others” and “a public scandal” and which organised the institution of the asylum around this danger in order to treat/contain it – to the reform law, Law 180 in 1978, which sanctioned for the person affected with mental illness the right to voluntary care in the community, not only marks a legal but a conceptual-practical transition as well. And it does so by denying the equivalence mental illness-social danger, giving the mentally ill person access to social citizenship and prohibiting the construction of new psychiatric hospitals. The Italian experience can be seen as a theoretical-practical process of deinstitutionalisation which begins with the asylum in order to move on to the deconstruction of psychiatry and illness.

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Research and Practice

Subjectivity and institutions: from Franco Basaglia to recovery Roberto Mezzina Keynote speech at the INTERNATIONAL MEETING “Franco Basaglia’s vision: mental health and complexity of real life. Practice and research”, Trieste, 9-­‐12 December, 2014. WHO CC for Research and Training in MH Trieste -­‐ Azienda per i Servizi Sanitari n.1 “Triestina” Today, the recovery movement seems to be almost as important for some as it was, a few years ago, the anti-­‐institutional movement, although players, methods and philosophies, even the powers involved, appear to be different and completely new. If that were the case, we would really be in the presence of a historical phenomenon and not just a passing trend, or, worse, a fashion. To quote Basaglia, it would not be a mere "change of ideology" from old psychiatric knowledge and powers (Basaglia, 1980), but a true paradigm shift in the field of health and mental health. On the other hand, if what happened in Italy could be seen as an anticipation of these issues – so dramatically topical today -­‐, it would be an important test of the topicality of Basaglia’s theoretical-­‐practical action and of the anti-­‐institutional movement over forty years later. The "recovery" construct was itself a challenge to medical-­‐biological reductionism in psychiatry, since it appeared possible, through it, to oppose the active role of the person, the importance of factors associated with his/her concrete existence, his/her empirical givenness, such to influence the course of his/her psychopathological condition not in a mechanistic and extrinsic, hetero-­‐ determined way, but through the significance of said factors within the world of an individual subject. Precisely because they are identified with this world, they must be contextualized, and so become founding elements of a reconstruction of subjectivity. The emphasis on factors and determinants that are internal and external to the person, subjective and social, versus naturalistic factors related to the "disease", is combined with the need to obtain answers to a whole set of needs and, simultaneously, to demand rights, in a process that sees the "sick person" as an individual and collective subject, protagonist of change in services, culture and knowledge. The task of today’s psychiatry would therefore seem to be that of refusing to seek a solution to mental illness as a "disease", but working to approach and consider this particular type of patient as a problem that – only because existing in our social reality – may represent one of the contradictory aspects to resolve which new approaches and treatment facilities should be set up and invented. (Basaglia, 1967, p. 420) Basaglia’s statement, therefore, calls into question the issue of the interpretative models of psychiatry and the very concept of disease, which has never been, and clearly is not yet so today, protected from criticism. The issue of paradigms was again revived strongly in the recent international reflection (Bracken, Thomas, Timimi et al. 2012; Priebe, Burns, Craig, 2013; Mezzina, 2005; 2012a). The reductionist neurobiological, "technological", paradigm which is connected to the medicalization of daily life and to the various forms of "biopower" (see Foucault), has re-­‐proposed invariances as founding principles of the scientific knowledge within a framework exclusively centered on the positivist vision of the sciences of nature, without taking due account of the crisis of scientific models inspired by the knowledge of complexity (as in the works of Von Forster, Prigogyne, Morin). Psychosocial aspects such as relationships, values and systems of beliefs, different practices are, in this logic, an afterthought if not openly disavowed. The wider definition of bio-­‐psycho-­‐socio-­‐ cultural approach seems to line up these different fields, but while recognizing the interaction, it does not return a meaning to us, in any case. From a theoretical perspective, the criticism of disease models, and particularly of the construct of schizophrenia and its heterogeneity, has now pushed the reliability of this, as well as of psychiatric diagnoses in general, to a critical limit (Bentall, 1990; Boyle, 1994; Buchanan , Carpenter, 1994), and similarly there has been a normalization of experiences such as hearing voices (Romme, Escher, 1989; Coleman, 2011), up to the attempt at reconstructing a meaning in the experience of madness (Geekie, Read, 2009; Read, Mosher, Bentall, 2004; Bentall, 2003); while there has been considerable advancement in the reflection on the limitations of the biomedical model (Rose, 2006; Whitaker, 2010) affected by the creation of a system of expectations, and related economic interests around pharmacological treatments.

Soteria – no restraint system in Italy Lorenzo Toresini, NEUROLOGIA CROATICA Vol 56, Suppl 5, 2007 The Soteria experience was founded by Loren Mosher in California at the ‘70ies. Soterias were open – no restraint facilities for young psychotic patients, mainly at their onset. Loren Mosher demonstrated that it is possible to treat psychosis also in the acute phase without utilizing restraint methods. In Italy Franco Basaglia began refusing binding patients at their beds in the Lunatic Asylum of Gorizia in the year 1961. He also abolished any isolation method. From this initiative begun a wide theoretical and practical debate in the whole Italy. Restraint started to be considered as an ethical question, rather than as an objective need of public order in the hospital. The whole psychiatric question was seen as a balance between the right to be cured and the defense of society from the disturbing people. It became clear that until then the defense of the society had been prevailing on the right to cure. Such a huge debate led to the endorsement of a national Reform bill in the year 1978, which provided the gradual but radical dismantling and closure of the psychiatric hospitals all over the Country. This process is still being implemented today. The former Psychiatric Hospitals where everywhere substituted by a range of alternative facilities. Mainly outdoors, open facilities, work facilities a. s. f. For those patients who required a hospitalization there have been opened a number (321) small Acute Hospital Wards. The latter can per low guess no more than 15 beds. Even if not everywhere, in many places (30%) such acute wards are run without restraining any patients. In a few of them the ward is run with the door open. At the end it has become clear how dismantling the structures leads to the dismantling of the illness itself.

Psychiatric reform in Italy this article details the reform of psychiatry which started in Italy after the passing of Basaglia Law in 1978 and terminated with the very end of the Italian state mental hospital system in 1998. Among European countries, Italy was the first to publicly declare its repugnance for a mental health care system which led to social exclusion and segregation.

From the inside out: the view from democratic psychiatry Terence McLaughlin, pages 63-66 European Journal of Psychotherapy & Counselling, Volume 6, Issue 1, 2003 Special Issue: Therapy from the Left: The Personal from the Political

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Videos and Presentations

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Organisations

Trieste Mental Health Department (TMHD)

TMHD is a public, community-based mental healthcare service which evolved directly from the pioneering de-institutionalisation experiences of Franco Basaglia and his collaborators in the 1970’s. Recognised for years as one of the most advanced public mental healthcare services in the world, the Trieste MHD continues to remain a leader in innovative approaches to mental healthcare aimed at the emancipation and social reintegration of persons suffering from mental disorders.The Mental Health Department forms part of the Trieste Local Healthcare Agency (LHA) n. 1 "Triestina", which was completely reorganised following the formation of a separate Hospitals Agency in 1997 (today University Hospital Agency). The purpose of this reorganisation, which took place primarily during the 1990's, was to provide more resources and impetus to community-based healthcare services, and re-balance what had been an excessively "hospital-centric" system.
The Trieste LHA covers the territory of the Province of Trieste, with a total population of about 245k, 210k of which reside in Trieste and the remainder in a handful of small municipalities (Duino Aurisina, Sgonico, Monrupino, Muggia, San Dorligo della Valle).

Address: San Giovanni compound
Via Weiss 5 – 34100 Trieste
e-mail: [email protected]
website:  http://www.triestesalutementale.it

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Links

Democratic Psychiatry History of the movement From Wikipedia, the free encyclopedia.

Basaglia Law History of the movement From Wikipedia, the free encyclopedia.

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