The Unconscious of History #1: Walls and Minds: The History of Psychiatric Asylums and Basaglia's Revolution
- May 15
- 12 min read
Introduction to the column: The Unconscious of History
History does not end in textbooks. It survives in the institutions we inhabit, in the ways we think about care, in the language we use to describe those who suffer. "The Unconscious of History" was born from a simple conviction: that understanding how the past has built the psychological categories we use today — of normality, deviance, therapy, exclusion — is a necessary clinical and intellectual act, not a nostalgic exercise.
Each issue takes a historical moment, a movement, a reform, a figure, and brings it into the present. Not to celebrate or condemn, but to ask ourselves: what of that moment is still alive in us? What does it tell us about today's practice?
The column is addressed to anyone who works or moves in the world of psychology — researchers, clinicians, students, educators — and to anyone involved in history or the humanities, with the curiosity to look at their own discipline from the outside as well. The Unconscious of History is born precisely at the intersection: it is not a text of psychology applied to history, nor of the history of psychology, but a space in which the two perspectives question each other, convinced that understanding the past helps us read the present better — and that psychology, to know itself, also needs to know where it comes from.
This month's theme: Walls and Minds: The History of Psychiatric Asylums and Basaglia's Revolution
For almost a century, Italy took one thing for granted: that people with mental disorders had to be separated from the rest of society. Not treated — contained. The asylum was not a poorly functioning place of care: it was a socially legitimised instrument of exclusion, where the psychiatric diagnosis functioned as a sentence without appeal.
In 1961, a young Venetian psychiatrist of thirty-seven was appointed director of the psychiatric hospital of Gorizia. What Franco Basaglia found there — and what he decided to do — would forever change the Italian psychiatric system and inspire reforms throughout the world.
This month we explore that story: its historical roots, the break represented by the Basaglian experience, the contemporary psychological categories that help us understand it — stigma, institutional trauma, therapeutic alliance, recovery — and, above all, the question Basaglia still leaves us with: how much of the asylum spirit survives in our current institutions, and perhaps in ourselves as clinicians?
01 — The world as it was: Historical, political and cultural context
At the beginning of the twentieth century, Europe had by now consolidated an institutional system for responding to mental deviance: the asylum. In Italy, the regulatory framework was defined by Law no. 36 of 14 February 1904, promoted by the then President of the Council Giovanni Giolitti, which officially established psychiatric hospitals and regulated their functioning (Law 36/1904). The first article established that people suffering from mental alienation deemed dangerous to themselves or others, or of public scandal, were to be kept and treated in asylums.
That clause of "public scandal" opened an enormous door to arbitrariness. It was not only a matter of clinical pathology: the asylum became the social container for everything that bourgeois society did not want to see. Women considered nymphomaniacs or melancholic (almost certainly suffering from clinical depression), homosexuals, prostitutes, political dissidents, children with learning difficulties or simply unwanted by their own families: all could be committed on the simple report of third parties (Il Post, 2018).
The figure is chilling: from 1913 to 1974, in the asylum of Santa Maria della Pietà in Rome alone, 293 children under the age of 4 were committed, and over 2,400 between the ages of 5 and 14 (Il Post, 2018). Admission took place compulsorily; after a provisional phase it could become permanent. With the entry into force of the Rocco Penal Code of 1931 — the code of the fascist regime — inmates began to be registered in the criminal record, effectively equating them with criminals. During fascism, the facilities also served as places of detention for political dissidents: between 1926 and 1941, the asylum population rose from 60,000 to 96,000 people (Il Post, 2018).
Inside these structures, life was that of prisoners, not patients: overcrowding, malnutrition, straitjackets, electroshock used not therapeutically but to sedate and render the inmates passive. The psychiatric knowledge of the time was still rudimentary on many conditions; the prevailing logic was that of custody and containment, not care. What we would today call chronic trauma from institutionalisation was, at the time, the normal backdrop of asylum life.
In 1978, before the law changed everything, Italy had 98 psychiatric hospitals with over 89,000 people committed (Il Post, 2018). Society took for granted that mental suffering had to be separated from the world, that the presumed dangerousness of those affected justified the loss of all rights, and that the boundary between "normal" and "pathological" was natural, objective, and clearly drawn by doctors.
02 — The fracture: The event, the figure and the conflict that cracked every certainty
The crack in the system opened slowly, and from multiple directions. On the international level, works such as Erving Goffman's Asylums (1961) had already introduced the concept of "total institution" to describe structures — including psychiatric hospitals, prisons and barracks — that systematically mortify the identity of their inmates, depriving them of social roles and the capacity for self-determination. In parallel, Michel Foucault, in Folie et déraison (1961), had shown how the birth of the modern asylum was a historical and political phenomenon, not simply a medical one: the confinement of those defined as "other than reason" responded to logics of power, not to therapeutic needs.
In Italy, the name that became the symbol of this fracture is that of Franco Basaglia (1924–1980). A Venetian psychiatrist with a phenomenological background, Basaglia took over the directorship of the Gorizia asylum in 1961. What he found there shocked him: patients reduced to non-persons, treated with coercive methods, deprived of any autonomy. Instead of adapting to the system, Basaglia decided to change it from within.
He eliminated physical restraints, abolished electroshock, opened the ward gates and introduced recreational activities, community meetings between patients and staff, and — radical for the time — the possibility for inmates to visit the outside world. The Gorizia asylum became a laboratory of transformation. In 1968, Basaglia published L'istituzione negata (The Negated Institution), a first-hand account of that experience which became a foundational text of the international anti-psychiatric movement (Basaglia, 1968).
Basaglia did not limit himself to reforming practices: he called into question the very category of "mental illness" as an instrument of social control, demanding that patients be recognised first and foremost as people, as subjects with rights.
It should be noted, as Badano (2024) highlights in research published in History of Psychiatry, that Law 180 was not the work of a single man: it was the result of a collective movement involving healthcare workers, intellectuals, activists, and a political context — that of the "historic compromise" and the Italy of 1968 — which had made possible a public debate on institutions. The Christian Democrat MP Bruno Orsini was the principal technical drafter of the law. Basaglia was, however, its soul and most powerful voice.
On 13 May 1978, the Italian Parliament passed Law no. 180, known today as the "Basaglia Law." It was the first law in the world to abolish psychiatric hospitals (Il Post, 2018). It prohibited new admissions to existing institutions, ordered their gradual closure, and oriented psychiatric care towards community and territorial services.
03 — The psychological lens: Trauma, power, identity and diagnosis: how to read this episode
Reading the history of asylums through developmental and clinical psychology opens dimensions that simple historical narrative does not capture.
The trauma of institutionalisation. What current research on trauma teaches us today — through the concept of complex trauma, chronic relational trauma and adverse childhood experiences (ACEs) — illuminates retroactively what was happening in the asylum wards. Prolonged exposure to conditions of helplessness, unpredictability, lack of control and systematic humiliation corresponds exactly to the mechanisms that produce profound neurological and psychological damage. Moreover, the institution itself functioned as a traumatising agent. The paradox was total: already vulnerable people were brought into a context that could traumatise them further.
The power of diagnosis. The psychiatric diagnosis is never a purely technical act: it is a social act laden with implications of power. Basaglia understood that behind the category of "alienated" lay not only a clinical condition, but a cultural and political construction. Following Foucault (1961) and the British anti-psychiatry of R.D. Laing, he denounced how psychiatric knowledge could become an instrument of control and normalisation. This did not mean denying mental suffering, but asking: who has the power to define what is normal? And to what end?
The total institution and the loss of identity. Goffman (1961) had shown how total institutions carry out a systematic process of mortification of the self: personal clothes are removed, uniforms are assigned, privacy is eliminated, every margin of choice is reduced. The result is what he called the patient's "moral career": a progressive dismantling of the pre-institutional identity and the construction of an institutionalised, passive, dependent identity. Those who left the asylum — if they ever did — often failed to reintegrate into the world, not because their condition had worsened, but because they had lost the skills and confidence necessary to do so.
Prejudice and stigmatisation. Social psychology offers us tools to understand how prejudice against the "mad" was structured and perpetuated. The stigmatisation of the mentally ill was not an episodic distortion: it was functional to the system. Making the inmate a radical "other" — dangerous, unpredictable, irrational — justified their exclusion and rendered their suffering invisible. This dynamic still has effects today, in the more subtle forms of stigma that people with mental disorders encounter in work, relationships and access to services.
Developmental psychology and committed children. Perhaps one of the most disturbing aspects is the fate of the children locked up in asylums. Current attachment theory and research on neurocognitive development tell us clearly that separating a child from their primary caregivers — and immersing them in a chaotic, impersonal environment devoid of adequate stimuli — produces permanent damage to emotional, cognitive and relational development. Many of those children, in all likelihood, had no significant psychiatric condition: they were poor, orphaned, or simply "inconvenient."
04 — The legacy: What really changed. What the reform left us
Law 180 of 1978 marked an epochal turning point, but its legacy is complex and still controversial. On the formal level, the asylums were closed — definitively with Law 724 of 1994, which set the final deadline for the dismissal of all residual structures. In their place arose the Community Mental Health Centres (CSM), the Psychiatric Diagnosis and Care Services (SPDC) in general hospitals, and a network of community residential facilities.
What truly changed was a paradigm: the person with a mental disorder ceased to be — at least in principle — a subject to be kept in custody, and became again a citizen with rights. Compulsory psychiatric treatment (TSO) remained possible, but as a circumscribed and temporary exception, not as the norm. Community psychiatry — working with people in their life context — became the reference model.
On the international level, the Italian reform inspired similar movements in many other countries and influenced the debates of the World Health Organisation on mental health (Badano, 2024). Basaglia's approach — recognising the person before the pathology — is considered a precursor of current recovery models and user-centred practices.
Yet the legacy is also made up of shadows. The closure of the asylums often took place without adequate construction of the network of territorial services. In many areas of the country — especially in the South — mental health services remain chronically underfunded and incomplete. The result is that a significant proportion of people with severe psychiatric disorders ended up in families (often without adequate support), in prisons, or on the streets.
As Peloso (2022) summarises in the volume Ritorno a Basaglia? (Return to Basaglia?), deinstitutionalisation was carried out halfway: the old system was dismantled without fully building a new one. The question Basaglia posed — how to guarantee care and freedom together — remains open.
05 — The open question: The unresolved knot. The connection with the present
The history of institutional psychiatry does not conclude in 1978. Law 180 marked a before and after, but the after was not linear. What remained open was not only an organisational problem — how many services to build, how many resources to allocate — but a deeper question: if the asylum had been the mirror of a certain idea of humanity, what had that idea become after its closure?
The data tell us that psychiatric suffering has not diminished. Mental disorders today represent one of the main causes of global disability, yet services remain fragmented and chronically underfunded in many areas of the country. The need has remained; what has changed are the frameworks in which it is received — or not received.
For those who work in clinical psychology and psychotherapy, the history of asylums continues to speak directly to contemporary practice. Not as a generic warning, but as an invitation to recognise dynamics that do not disappear with the institutions that generated them.
The asymmetry of power that structured the relationship between doctor and inmate has not disappeared with Law 180: it has transformed, become more subtle, and still inhabits every clinical relationship. Recognising it — without denying its necessity, but without ceasing to question it — is part of the work.
Likewise, the diagnostic categories that enabled decades of arbitrary commitments were not neutral tools then, and they are not today. This does not mean giving up diagnosis, but using it knowing that every label carries a history, and that this history can liberate or imprison.
Basaglia believed that mental health was the business of society as a whole, not just of clinicians. Community contexts — social networks, work, relationships — are protective factors that no individual intervention can replace. Yet the dominant models still tend to isolate the symptom from the environment that produces it.
Finally, there is a historical continuity that deserves attention: the logics of the total institution described by Goffman have not disappeared with the asylums. They recur, in different forms, in prisons, in certain hospital wards, in migrant reception centres, in some residential facilities for the elderly. Recognising them is part of the ethical mandate of those who work in this field.
Basaglia's legacy is not a model to be applied: it is a method. That of never ceasing to ask ourselves who we are excluding, how we are doing it, and in whose name.
06 — Recommended historical and scientific texts: For those who wish to explore further
Basaglia's foundational works
L'istituzione negata — Basaglia, F. (1968). Einaudi.
The manifesto text of the Gorizia revolution, a first-hand account of the experience and radical critique of the asylum system.
Che cos'è la psichiatria? — Basaglia, F. (ed.). (1967). Einaudi.
Collective theoretical reflections on the psychiatric system and its relationship with power.
Scritti (Vol. I and II) — Basaglia, F. (1981–1982). Einaudi.
Collection of the entire essayistic output, edited by Franca Ongaro Basaglia.
Classics of critical thinking on institutions
Asylums — Goffman, E. (1961). Anchor Books.
The text that defined the concept of "total institution" and its consequences for the identity of patients.
Histoire de la folie à l'âge classique — Foucault, M. (1961). Plon.
Genealogical analysis of the birth of the asylum as an institution of social control.
The Divided Self — Laing, R. D. (1960). Tavistock.
Phenomenological perspective on schizophrenia, pioneering in British anti-psychiatry.
Historical and sociological studies on the Italian reform
Ritorno a Basaglia? La de-istituzionalizzazione nella psichiatria di ogni giorno — Peloso, P. (2022). Edizioni Pendragon.
Historical and critical analysis of the developments and outcomes of the reform up to the present day
The Basaglia Law: Returning dignity to psychiatric patients — Badano, V. (2024). History of Psychiatry, 35(2), 226–233.
Academic study on the historical, social and political factors that led to Law 180
Matti per sempre (webdoc) — Lanza, M.G., & Sala, D.
Journalistic investigation into the history of those committed to Italian asylums, with archival sources. Available at: mattipersempre.it
Reliable online resources
State of Mind – Bibliographic entry on Basaglia: stateofmind.it/bibliography/basaglia-franco/
Ministry of Health – Mental health from the Basaglia Law to today: salute.gov.it
Il Post – History and legacy of the Basaglia Law: ilpost.it (13 May 2018)
"Freedom is not the absence of walls. It is the ability to notice the ones we cannot yet see."
Conclusion
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Bibliographical References
Badano, V. (2024). The Basaglia Law: Returning dignity to psychiatric patients. The historical, political and social factors that led to the closure of psychiatric hospitals in Italy in 1978. History of Psychiatry, 35(2), 226–233.
Basaglia, F. (ed.). (1967). Che cos'è la psichiatria? Einaudi.
Basaglia, F. (1968). L'istituzione negata: Rapporto da un ospedale psichiatrico. Einaudi.
Basaglia, F. (1981). Scritti (Vol. I). Einaudi.
Basaglia, F. (1982). Scritti (Vol. II). Einaudi.
Foucault, M. (1961). Folie et déraison: Histoire de la folie à l'âge classique. Plon.
Goffman, E. (1961). Asylums: Essays on the social situation of mental patients and other inmates. Anchor Books.
Il Post. (2018, 13 May). Il 13 maggio 1978 furono aboliti i manicomi. https://www.ilpost.it/2018/05/13/legge-basaglia-chiusura-manicomi/
Laing, R. D. (1960). The divided self: An existential study in sanity and madness. Tavistock Publications.
Legge 13 maggio 1978, n. 180. (1978). Accertamenti e trattamenti sanitari volontari e obbligatori. Gazzetta Ufficiale della Repubblica Italiana, n. 133.
Legge 14 febbraio 1904, n. 36. (1904). Disposizioni sui manicomi e sugli alienati. Gazzetta Ufficiale del Regno d'Italia.
Peloso, P. (2022). Ritorno a Basaglia? La de-istituzionalizzazione nella psichiatria di ogni giorno. Edizioni Pendragon.
Psychiatry Online Italia. (2023, 10 February). Recensione: Ritorno a Basaglia?
State of Mind. (n.d.). Basaglia Franco: La vita e il pensiero del padre della psichiatria moderna. https://www.stateofmind.it/bibliography/basaglia-franco/
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