PSYCHIATRIC INSTITUTIONS OF ITALY
Italians have had a hard time recognizing once and for all that their old sanatoriums and asylums scattered throughout Italy were only places of seclusion for people considered “unwanted”, and not fancy rest and recreation houses as they have always wanted to pass off. We wish they had been, places where they could heal, or at least partially alleviate, already tortuous and complicated mental illnesses. But unfortunately, nothing was further removed from reality, far from finding protection and understanding, the people who fell into these cuckoo’s nests, for one reason or another, were for society mute individuals, without rights or freedom. Where they also suffered serious physical and psychological torture.
The Code of Hammurabi, ancient engraving from Mesopotamia of nearly 4,000 years, they already warned us of the damage that can cause the pretension and aberrations of human nature. Twice it referred to “a duty to protect the citizens of possible negligence or medical errors” .
A side of Italian history, perhaps less well known, but which undoubtedly adds another absurd reality of an increasingly disconcerting society.
THE ITALY OF HORRORS
Undoubtedly, the idea of creating these places of confinement was taken from the old existing lazarets from the 15th century (precisely the first was founded in Italy in 1403, on a small island near the city of Venice).
Initially the lazarettos, often close to the coast, were destined for the mandatory quarantine imposed on the sick arriving from the ships. Later these places were destined to also confine people with infectious diseases and considered contagious, such as leprosy or tuberculosis. They were unhealthy places, cut off from the rest of the world, where sick people did not receive any kind of medical care and survived amid the filth until the end of their days consumed by hunger and suffering.
Although more organized and with more resources at their disposal, the Italian psychiatric sanatoriums of the 19th century performed the same identical function as the old Italian lazarets, that is, to confine people who were “uncomfortable” for society. These, however, were considered institutes, and not simple asylums, where in addition to caring for the “claimed to be” mentally ill, their alleged illnesses were investigated.
Today it is unquestionable to say that in those asylums, not only patients with mental disorders entered, but also healthy people, whose only fault had been to represent a ” discomfort “, a risk or simply a social shame.
Many homeless Italians ended up in these madhouses. The list of “unfortunates” could not be more shameful: abandoned children (even infants), generally illegitimate children born out of wedlock, the fruit of love affairs and abuse of maids. Children rejected by the “shame” that some physical or mental diversity supposed. Children born and abandoned due to the precarious conditions of poverty. Homeless prostitutes and beggars. Deaf, dumb, blind, lame, handicapped peopleand paraplegic in general. The homosexuals were accused unjustifiably and even the women coming from Sardinia, they were often accused of being witches because they spoke another language (in Sardinia they speak their own dialect), and with that excuse were rejected and discriminated against because they don’t understood nor spoke the Italian language.
Already in 1874, a ” project of regulation and reform ” for the alienated and mentally ill had been proposed by the inmate minister Girolamo Cantelli, but it was never carried out. Later in an “inspection in the asylums of the Kingdom”, made in 1891 by the then minister of internal Giovanni Nicotera, he denounced numerous shortcomings and disadvantages presented structures, deterioration of local, shortage of resources food, inadequate instruments cure, poor hygienic conditions, as well as the lack of clinical records and the over-saturation and abundance of patients or overcrowding, which made the management of the asylums more difficult.
Despite these warnings and reprimands, nothing was done about it, and in the absence of a national law regulating the management of the asylums, a legal vacuum was created where everyone did as they wanted. The confinement to the madhouses was done without control, arbitrarily, justified with a variety of options to choose from, such as a medical certificate, a simple authorization from an official or mayor, an authorization from a religious congregation, or the request of a relative, or by having the status of convict.
At the beginning of the ‘900 the deplorable conditions inside the asylums were unsustainable, and in 1902 Giolitti presented the basis for a law. With which Law 36 would be created in 1904, which would try to improve the situation, which was not the case however.
In 1905, just a year after the controversial Law 36 came into effect, of inmates (who they claimed to be mentally ill) Italian asylums housed nearly 40,000 people, but the number still increased dramatically during the fascist influence. The asylum became an effective weapon tosilently “eliminate” a socially and politically threatening figure, who was not always easy to persecute, that of the political opponent and dissident; and homosexuals. According to them their country was full of madmen.
LAW 36 OF FEBRUARY 14, 1904
This progressive and indiscriminate increase in people, also healthy of mind, within the Italian asylums, was promoted and facilitated by the aforementioned controversial Law 36 of 1904. Which provided on the “duty” to have people affected by any mental alienation, under surveillance and cared for within the asylums. Law 36 provided for people to enter the asylum when “they are dangerous to themselves or to others, or are a risk of public scandal”, and “they are not or cannot be adequately monitored and cared for outside the asylum. “
In addition, in article 2 of the same law, it provided that the admission of the alienated in the asylums should be required by the “relatives, guardians or tutors, or any other person who does it in the interest of the patient and of society”. And it was authorized provisionally, presenting a simple medical certificate. With a maximum observation period of one month, which could then be definitive, and in fact it was.
Above the law 36 conferred on the “local security authority”, that is, the municipal guards, “in case of emergency”, order immediate admission, also with only the infamous medical certificate. And they appropriated all their goods.
Such a prerogative, which the law provided for, although it was initially exceptional, soon became an ordinary circumstance, applied with such ease that it offered the police andforces of public order to intervene against any “annoying” person without activating the judicial and legal mechanisms of guarantee that were active in the penal codes.
As we can clearly see, Law 36 provided an easy avenue for corruption, where fraudulent medical certificates could be conveniently drawn up in exchange for money or favors from influential people, and certainly also the local police were bribable and abused their power.
We have to understand the Italian mentality of those times, today still deeply rooted in so many prejudices that still dominate the daily life of Italians. A predominantly hypocritical mentality, under the guise of a morally correct society and in line with the most sexist and intransigent Catholic traditions.
The social image of the Italian family was, and still is fundamental, so it had to be avoided “at any cost”, all kinds of public scandals. Appearing to be a perfect family, without errors or sin, was a constant desire among the Italian castes. Envy was undoubtedly at the base of all this staging. The criticism of others had to be silenced to ensure the popularity and reputation of the male family name. Notoriety was so important that they did not give up on doing any kind of act, even if it was unfair and dehumanized, to hide a bad thing or uncomfortable situation from a member of the family. It was enough that it was done clandestinely and in silence, with the tact and discretion that money and favors of some undeserved privilege always allow.
There were no age limits for admission, it was enough for the doctor to declare that the child was dangerous for them or for others. That is why even very young children were admitted, just because the families could not or did not want to have them, perhaps they had some small learning disorder or hyperactivity, any excuse was valid to be rejected and separated.
Between 1913 and 1974, in the asylum of Santa Maria della Pietà in Rome, 293 children under 4 years old were interned, and 2,468 between 5 and 14 years old.
This evident anomaly of the law made at the base, a kind of alliance between psychiatrists and guardians of order that authorized the entry not of “crazy”, but of paralyzed, vagabonds, alcoholics, degenerates, all people who “according to them could give scandal”, and that locked in the madhouses, they stopped being a problem for the society and for the family, that paid with money or favors.
The fact is that this law thus allowed all kinds of abuses, of course there were so many who took advantage of it. “Putting in the madhouse” became the best, fastest and most effective instrument to “get out of the way” to uncomfortable people, bypassing the long, complicated and expensive legal issues.
ALREADY IN THE TWENTIETH CENTURY
Beginning in 1927, the number of Italians in asylums increased steadily every year, in less than 20 years it went from 62,000 to 95,000 inmates.
In the times of fascism, the so-called “crime of the regime” relieved the darker side of politics, sending many “political prisoners” into asylums. The fraudulent and illegitimate use of Italian psychiatric hospitals did not end with the fall of fascism, least of all with the end of World War II. In the years following the liberation, many “ex partigiani” were unjustly accused of serious crimes committed during the clandestine struggle, and were “provisionally” admitted to asylums. But there is documented evidence that the political inmates who in theory should only stay in the asylums for a short time, in reality stayed for years indefinitely, abandoned in total silence, ignored by the institutions and political parties.
THE BASAGLIA LAW
In the 1970s Italy was shaken by new European trends in political and social reform. The political pressure transmitted by these European countries put Italy on a forced path of socio-political reform. Driven by daring social and political movements that challenged the foundations of a particularly traditional society, such as unions, university groups, left-wing radicals. The emerging new Italian society called for innovations on workers’ rights, abortion, divorce and also the 180/78 law, among others.
As a result of this growing social pressure andsocial demands, in 1978 the Italian government decided to abolish all Italian asylums, with the so-called Basaglia Law of the 13th may, n. 180.
Although it is sad to admit, the Italian government created the Basaglia law to silence these attacks and social criticisms, more than for the sense of dignity, good sense and justice that the claims carried inherently. In this way, in the (traditional Italian way) they managed and settled quickly by hiding that issue. So uncomfortable and embarrassing, especially for the image it gave of the emerging Italian political class after the dictatorship internationally.
With the arrival of the Basaglia Law, it had somehow been recognized and shown that in Italian asylums, all that “progress” was just a facade. People had been unjustly hospitalized both sick and “healthy”. Their rights and freedoms had been denied andtheir dignity ignored. The inmates had been treated without respect, systematically using humiliating methods and torture with the aim of being manipulated and used in clinical experimentation.
Despite all those “innovations” in facilities, management and even recreational facilities. The reality had been different. They had not been properly nourished and hygiene had been poor, there were not enough or at all qualified personnel to guarantee the slightest hygiene requirements. Inmates had been exploited in unpaid work. The physical and psychological mistreatment and abuse had been called re-education. And torture had been practiced within the clinical experimentation applied in the so-called therapies or treatments, such as the inoculation of pathological germs, injections of drugs, lobotomies, electroshock, torture with water and steam, immobilization, isolation, friction with irritants, etc.
The therapies used had been inappropriate, totally unjustified, and egregious. Although at the time they were recognized as an advance in medicine and some even touched the Nobel. They did not correspond to an ethical criterion that seeks the well–being of the person, but on the contrary, it caused harm and suffering, and they had clearly been an aberration, on which they fed only to advance in their hypocritical claim.
The Basaglia Law as such, had a short life, since it was replaced a few months after its approval by Law number 833 of December 23, 1978, which instituted the National Health Service, and which incorporated the previous provisions of the Law Basaglia along with some tweaks.
Although its effective application took a long time, the Basaglia Law meant a great reform of the psychiatric system in Italy. It provided for the closure of all asylums and led to their gradual replacement towards community services outside the hospital network.
There were different ways of managing change in each region, since the same Basaglia law had entrusted the management of asylums to local authorities. It took more than 20 years to be integrated and finally the asylums were closed and replaced by CSM mental health centers within the National Health Service.
In other words, psychiatric units would be opened within general hospitals, with a limited number of 16 beds, somewhat lower than the world average. Mandatory treatments within hospitals would be exceptional, as long as the patient did not accept treatment outside the hospital or the community entities could not be accessed. Patients would be gradually discharged according to their state of recovery and integrated into society.
Finally, a law said that the mentally ill should be cured and discharged, and not confined. Psychiatric facilities were no longer places of seclusion, and the mentally ill enjoyed civil rights like any other citizen, and integrated into society. At last it seemed that the whole context had finally regained its sanity lost in previous decades.
But it was not like that, the people “discharged” were abandoned to their destiny, forgotten about by the institutions, they did not have any kind of guidance and follow-up once they were out of the asylum. They were destined to suffer “stigmatization” by a society that had not changed. The same one that had sent them to the madhouse. They returned to the same social environment where they had been rejected, confined, insulted and mistreated. A society that considered them inferior and unacceptable, and looked down on them. A society that was considered superior formed of “sane” individuals as well as decent, honest and morally impeccable citizens.
Curiously, this contradiction and dissonance is a typical behavior of a dehumanized and hypocritical society. Whose unjustified aversion to these vulnerable and supportive people only shows low self-esteem. It is stigmatized to increase low self-worth, and this leads to dehumanization. People who stigmatize others shed their human characteristics.
But there was also another problem arising from this new situation, which they had deliberately ignored. Some medical sectors complained about the unsanitary conditions and the neglect of the mentally ill detained in prison. Italian prisons had become warehouses for the mentally ill. Those incarcerated with mental illness did not have any type of medical assistance or therapy, they were abandoned by a government occupied with other issues.
Although they tried to mitigate the controversy, the debate was also highly contested in Italy, not so much on a moral level, but above all because of its socio-political implications. The discussion and the scandal led to international debates and commissions that criticized the indolent way of the Italian government in dealing with such delicate matters as this one. Since according to international opinions, the Italian government had created in its country a “dichotomy” in the treatment of metal health. Since they did not treat all the mentally ill equally. Among other things, it ignored the situation of prisoners with mental illnesses, who were not given any other option, but to remain confined in prisons with indeterminate sentences, depriving them of all kinds of civil rights.
The Italian experience demonstrated the inveterate way of solving thorny situations, that when there are no convenient solutions for those in charge, difficulties that require commitment and money can be avoided.
This same situation was repeated in other countries, and today it remains an unresolved situation in many of them. Approximately between 8 and 10% of inmates suffer from a serious mental illness, and between 40 and 48% have mental and personality disorders (although they are not unimpeachable), to which must be added another percentage of mental disabilities, which also include drug addicts.
Only exceptionally are they treated within prisons, since no type of preventive, treatment or rehabilitation program is foreseen. Nor is there any type of support, guidance, treatment or monitoring once the sentence is over. When they leave prison they are left to themselves.
And for this reason, approximately 50% of the mentally ill usually commit a new crime because they have suffered a psychotic break due to lack of medical treatment. Experts confirm that if there were alternative residential centers for the chronically mentally ill who do not have family support and who live in socially marginal environments, the imprisonment of said mentally ill patients would be avoided, since according to statistics 90% of these patients lack from home and has no job.
Florence Nightingale (a British nurse who cared for the soldiers in the Crimean War), indicated the way in which nursing and care of the sick should go : “to ensure hygiene, nutrition, rest and healing of wounds. Done with respect and consideration for the wounded soldier”. No wonder their emotional presence, their favorable mood in those moments so critical and their interest for the speedy recovery of their patients made that would reduce deaths by 40%.
One of their mottos was: “the patient must be placed in the best possible conditions, so that nature acts on them.”
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