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Reviewing John Foot ‘The man who closed asylums’[1]

This is an urgent book that is about much more than anti-psychiatry or movements allied with it. It is a book about an era of situated political change: situated geographically, historically and socio-culturally and animated by an awareness of the proximity of massive changes, in apparently discrete areas like mental health care, to discourse of global social change. Some of these discourses were naïve, as Foot shows, and some exaggerated their historical, if not their aesthetic importance – such as the episode of the Marco Cavallo.

‘Marco the Horse’ was the name of the dray horse which carried goods and other things in and out of the hospital – famed by inmates as the only named thing that ever, other than the staff, got out of the hospital. Emerging as a partial and symbolic product of the long and complex networks of democratic meetings inside the most radical of the psychiatric experiments, that of the asylum at Reggio Emilia, Marco became mythicized and in various sculpted forms, originally in papier-maché, was the symbol of the reversed myth of the wooden horse of Troy – a liberation where a horse and an army of the branded ‘mad’ dramatized the story of the period of ‘decarceration’ of asylum inmates.

A bronze Marco Cavallo still exists in the city but people have forgotten its significance. It graces the university grounds where once the ‘mad’ were incarcerated – locked in closed wards and often living in their own faeces, subjected to treatments that seem to us now, and did to the inmates then, like torture. One of the first small steps in the movement, started by Basaglia in Gorizia, an asylum on the Yugoslav border, was stopping the tying of children who had been labelled ‘insane’ physically to their chairs or beds. And here is the politician, Tommasini’s (one of the first to reject the idea of anything less radical than asylum closure), first visit to the asylum in Perugia:

…a vision of hell. In one small room, there were around sixty women, ‘who were screaming and rolling around on the ground, sometimes in their own excrement.’

But the book shows how much the anti-asylum movement, leading to the slow closure of all Italian asylums after Law 180, in May 1978, owed much to the great diversity of Italian politics and its history of alliances between what the great Italian Communist leader, Antonio Gramsci (who died of neglect and starvation in Mussolini’s prisons), called historical ‘blocs’. These were historical groups, diverse in nature but ready to unite over specific change. Historic blocs like the Roman Catholic Church, The Italian Communist Party – PSI - (in whose areas decarceration started), intellectuals and reforming professional teams and even the Centre democratic Parties. It is a politics that needs to be studied in these deep and dark days of right-wing hegemony that Theresa May is trying to bolster under the flag of a nostalgic nationalism.

In Italy nationalism in the 1970s got tied to forces for progressive (but not necessarily ‘left-wing-inspired’) changes, such as the closure of the asylums and the secularisation of laws binding women (under the eyes of the Catholic Church at one of the moments of its greatest reactionary fervour in personal politics). This is a politics we yearn for in the present.

Yet this is not ever a book of polemic. Politics were merely part of the discourse of Italian reform. The most moving moments in this book are the narratives in which the agency of the incarcerated began to show itself in political discourse and agency. Transcripts of meetings in which they spoke and voted and acted form part of the movement’s great flagship publication: The Negated Institution. It was also demonstrated in acts of physical openness – the tearing down of fences and walls: ‘the people took the fence down’ as Gheradi reports of the asylum in Arezzo.

This is only partially a book about a man, Franco Basaglia, it is about a movement, which inspired his lifelong learning and his agency as a reform leader and who died on the eve of reforms being brought to a general conclusion, if only then in Italy. It is about many people: people who learned to stand against institutionalisation. It does not balk at stating the naivety and over-simplicity of some of the ideas of the movement or noticing the great risks it took. It is a book about the triumph of humanity inspired not just by Goffman, Laing (who rather prevaricated when it came to the real social issues and deferred to mysticism) and Maxwell Jones, but by Primo Levi lessons about the ultimate institution, the concentration camps in Fascist Europe, a phenomenon recently re-emerging in the ghettos of Calais and, of course, a true great British invention (in the Boer War). Indeed the English-speaking tradition of reform emerges as rather limited and contradictory.

I love this book. It is about faith in democracy – direct democracy of the sort we envisage in 5th Century BCE Athens (p. 331):

Meetings performed a variety of functions; they had ‘cultural value, a social value … They were also a ‘collective epistemological process’, giving a sense of identity to the patients … They felt very important at the time. The patients were given a platform; it appeared they had power. As to their long term influence, this is still to be assessed.

This is historical prose of the first magnitude. Read it if you can.

All the best

Steve