I wish to comment of the “AntiPsychiatry Movment” as this month there has occurred a little known but imporant anniversary this very month of May at the time of this writing, May of 2018. First I will set the stage a bit laboriously by outlining the several main fields of focus for this movement. At least one of these “anti-psychiatry” movements was well placed, needed, healthily revolutionary and far sighted, Some of the others have been dismal flops, misguided lunatic efforts in the service of lunatic philosophies, and/or instrumental in generating monstrous new social problems.
There have been three forms of the “anti-Psychiatry” movement over the last half century or more.
In the USA the movement has focused on treatments that were, and/or seen as abusive, cruel or inhumane. These villified treatments concerned mostly the first few decades of the use of ECT, or electoconvulsive treatment, and psychiatric medications. In the last few decades ECT was refined to a point that its visually frightening quality of causing gross, big time seizures of muscles with all the scary “herking and jerking,” as I always term it in lectures, so that medications suppressed and eliminated those aspects that gave it a “bad” reputation. ECT was the only effective treatment for psychotic or serious mental illness for more than two decades until the advent of psychiatric medications commenced in the 1950’s and 1960’s Ritalin has long been the focus of certain advocacy groups as the second prong on the American anti-psychiatry groups as far as treatments.
The second main front on the anti-psychiatry movement has been the focus on the social phenomenon of institutionalization, or the inappropriate use of the state hospitals, large asylums, to house the chronically mentally ill for incredibly long periods of time, or lifelong, turning psychiatric hospitals into convenient warehouses for the mentally ill, keeping them out of the sight and awareness and social responsibiity of the rest of American society and of other western societies as well. Psychiatric hospitals became de facto prisons since hundreds of thusands of persons were confiend to hospitals lifelong for not only grossly obvious psychotically bizarre behaviors but also petty offenses such as being poor, chronically inebrited etc. These latter “status offenses” as they were called in more modern times when applied to juvenile offenders were more common the 1800’s than is commonly known.
To fill out in graphic detail how awful institutionalization was in the more distant past, thought not to detract from its equally awful forms in the recent past, I would specifically recommend a brand new book by Stacy Horn, Damnation Island: Poor, Sick, Mad, and Criminal in 19th-Century New York that documents so many themes not appreciated by many (me among them!). This book covers the history of Rikers Island, the prison island for New York City when it was the psychiatric hospital/dumping ground. I will not list its many themes except ones pertinent to this discussion. The institutions(s) there on Blackwell’s Island as it was known then, hospitalized as many poor as it did mentally ill. One could end up there for the most mild of status offenses, being drunk or even just homeless. The place also was so filthy, poorly maintained and unsanitary that it had repeated outbreaks of dysenteric illnesses, death rates were high from many causes of poor care and physical neglect. But also it saw the employment of the cruel treatments in the centuries before modern treatments were discovered, such as straitjackets, prolonged restraints, and all kinds of water based horrific “treatments,” including practices that were nothing short of waterboarding of recent scandals in our times.
The third main front of the anti-psychiatry movements have been more politically based. Other than goofball schemes of the Cold War in the USA, American psychiatry did little in the way of evil social psychiatric practices. Those fields of endeavor have largely been occupied by the totalitarian regimes, especially pre and post Soviet Russia. Political suppression and imprisonment in Russia was widely practiced and state sanctioned through recent decades. This caused many psychiatry organizations such as the World Psychiatric Organization, the American Psychiatric Association and the other professional psychiatric guilds of western countries to denounce Russia’s practices and the complicity of Russian psychiatric by the time of and after the 1970’s. In Russia psychiatrists aided the state in repressing dissidents and other so-called enemies of the State by committing to stretches in psychiatric hospitals that were in essence state prisons. Persons were held without cause, without review, without legal redress etc. Stories of these practices seeped out but became better known especially when Soviet Jews were allowed to start leaving Soviet Russia after the internaitonally publicized efforts of writers and efforts of Natan Sharansky and others. As those persons left the country, many verified accounts began to be made known through media in Israel, Europe and the United States.
Now that i have set the stage historically as I like to do, I wish to hone in on the particular anti-psychiatry movement that I think was well placed, well done and the most influential of all and the least known in my circules.
And that is the legacy of the French psychiatrist and hero to me at least, Dr. Franco Basaglia. I just recently this past week as it turned out penned a blog post on this figure who has not received enough attention and acclaim in my not terribly well informed view for his incredibly efforts. He was a prophet not well honored in own vineyard during most of his somewhat short life. He worked truly heroically in a modest small town and pioneered opening up awful psychiatric institutions, “empowering’ (I hate that word as it is overused, but it fits here) patients, starting patient governments, making staff doctors and patients all partners, etc. His efforts were far better, more responsible, well thought out, and therapeutic than the goofball, loosey-goosely hippie era, woefully naive and downright stupid efforts of the slightly later doyens of de-institutionalization such as R. D. Laing of Britain.
Dr. Basaglia’s efforts came to be so well recognized for their worth in his home country of Italy that a national law of reform was passed. This law and country paid suitable homage and recognition to Basaglia in that the law came to be called the Basaglia Law. It forever abolished all involuntary commitment and state hospitals in Italy in the 1970’s.
I would like to insett wholesame a quote from an article published yesterday that is the stimulus for this post. Yhe writer, Julian Vigo, in the publication Truthdig, entitled: The Legacy of the Anti-Psychiatry Movement wrote eloquently of Dr. Basaglia’s efforts and I cannot state the great significance of the man and this anniversary betterrr than he; so I will plagarize a bit and grace the reader with Mr. Vigo’s text that makes the point so well”: “Last week marked 40 years since Franco Basaglia’s revolutionary work in Trieste, Italy, led to the groundbreaking Legge 180 (Law 180, also known as “Basaglia Law”), which ended the practice of involuntary confinement in asylums throughout Italy.”
This is a stunning achievement that still stands to this day and would be impossible in the USA still. Italy did a wonderful thing, duplicated only in Belgium in the town of Geels. And that is, both these societies made total social change in practice and attitude on how the adult mentally ill were handled and it is did not start with lengthy hospitalization. They erected outpatient social systems that were pervasive, existing everywhere even down to the individual home/family level. In our society unfortunately we still suffer from the curses of seeing differences as weird, strange, immoral, politically antithetical, etc., and believing that someone else should take care of any problem.
In a show of writing excess, I would propose from an historical psychiatrist’s point of view, that we should have in addition to Bastille Day, a new holiday, Basaglia Day to annually remember the true advent of healty de-institutionalization that worked far better in Italy than our bumbling, socially insane efforts in the USA.