Psychiatry without asylums: origins and prospects in Italy

In 1978, Italy became the first country in the world to pass a law eliminating mental hospitals and replacing them with services in the community. This victory was in large part due to the foresight and commitment of psychiatrist Franco Basaglia and his colleagues, whose work showed how psychiatric assistance could be realized in practice without asylums and without force and violence. This article analyzes why the anti-institutional reform took place in Italy when it did, and reviews twenty years of reform activity involving an alliance between democratic mental health professionals, politicians, workers' organizations, and private citizens. Although the reform gives psychiatry the opportunity to transform itself into a science of liberation, conservative political and scientific forces are attempting to maintain the logic of the asylum and replace the mental hospital with other institutions which continue to practice segregation in a decentralized form. The outcome of this radical experiment in creating a nonrepressive psychiatry remains uncertain.