Breaking Through The British Psychiatric Information Blockade: The Real Dope on Basaglia

There are the doctors, white gowns, orderlies and nurses, just as in a general hospital, but in reality a psychiatric hospital is a custodial institution where medical ideology is an alibi for the legalization of violence [9].
332 CLASSICS OF COMMUNITY PSYCHIATRY
At the heart of institutional psychiatry, then, was a lie, a gross deception: the institution existed not to answer the real physical, social and psychological needs of the patients, but rather to serve its own needs and those of the social order whose interests it represented, If the hospital was, in reality, a prison, and the hospital workers were prison guards, then reasoned Basaglia, there must have been a crime. But what crime had these unfortunate inmates committed? Unlike ordinary criminals, he concluded, psychiatric inmates were confined not for what they had actually done, but rather for the ‘phantom’ of what it was they might do, for what was presumed could happen. Institutional psychiatry was justified, in the final analysis, by the constant over-prediction of the dangerousness of the common mental patient, recruited from the marginalized, asocial and potentially unruly Italian underclass. This anxiety was clearly articulated in the existing mental health legislation (see below). In addition to the problem of potential dangerousness there were also the frequent violations of probity associated with the underclass—-the public disgrace and scandals occasioned by the ‘disorderly conduct’ of the impoverished and working class ‘mentally ill’. Here lies the core of Basaglia’s class analysis of psychiatry. Basaglia recognized that psychiatric diagnoses were not independent of the prevailing moral and social order which tended to define normality and abnormality in its own class-based terms. There was, of course, the observation that the Italian public institutions—mental hospitals, orphanages, and reform schools-——were crowded with the poorest and most marginalized classes of Italian society. Many of the inmates were aggressive adolescents and unemployed young men; many were women who deviated from the rigid gender norms of Italian society, the demands imposed by lower class marriage and family life. The presumed and intuited ‘dangerousness’ of these inmates could be linked to their ambivalent relations to societal norms, especially those related to conventional productivity and reproductivity. We could interpret their ‘passive refusal’ to participate in the commonsense but highly exploitative terms of productive and reproductive labor as a wildcat strike, thus explaining the need to remove them (forcibly if necessary), lest the strike spread to the rest of society.
Psychiatry, then, provided an ideology to cover over the layers of contradiction underlying the medical rationale for institutionalized violence against the classes of alienated poor found in the back wards of most public mental institutions. Basaglia concluded:
Once the medical pretenses are gone, we can see the misery and the poverty that are the true nature of the asylum. The specificity of madness is also gone. The deception is obvious: it is one thing to say that an institution locks up fifty ‘sick’ people. It is quite another to say that fifty ‘poor’ people have been locked up because there is no other solution to their problems [10].
If institutional psychiatry was a lie and a whitewash for what was, in reality, a covert apparatus of brutal social control, then asylum psychiatrists were the original masters of deceit, or in Basaglian terms, ‘special agents of public consensus’, masquerading as men and women of science, and as caring and compassionate physicians. Institutional psychiatrists acted in the capacity of traditional bourgeois intellectuals, as defined by Gramsci, to swallow and ruminate any new type of thought, including even the most indigestible ideologies, in order to preserve the hegemony of the dominant social classes, whose interests they are paid to protect and to represent. Above all, it was the function of the psychiatric technicians to deny, to fail to see the reality of human needs expressed through psychiatric symptoms, especially the poverty and the exclusion of the mental patient both inside and outside the asylum. For Basaglia the psychiatric technicians diagnosed, with greater and greater precision and specificity, thus fragmenting the problem of ‘mental illness’ into 4 multitude of diseases so as to avoid confronting its wholeness, its unifying dimensions as a shared experience of alienated human needs.