Psychiatry Inside Out: Selected Writings Of Franco Basaglia

Selected Writings of Franco Basaglia Edited by Nancy Scheper-Hughes and Anne M. Lovell Foreword by Robert Coles PSYCHIATRY INSIDE OUT: SELECTED WRITINGS OF FRANCO BASAGLIA EUROPEAN PERSPECTIVES A series of the Columbia University Press Psychiatry Inside Out: Selected Writings of Franco Basaglia edited by Nancy: and Anne M. Lovell Foreword by Robert Coles Translated from the Italian by A n n e M . Lovell and Teresa Shtob C olum bia U niversity Press N e w York 1987 Library of Congress Cataloging-in-Publication Data Basaglia, Franco. Psychiatry inside out. (European perspectives) Selected and translated from Scritti. Bibliography: p. 1. Psychiatry. 2. Psychology, Pathological. 3. Psychotherapy. I. Scheper-Huges, Nancy, n. Lovell, Anne. m. Title. IV. Series. RC458.B362513 1987 616.89 86-23287 ISBN 0-231-05718-0 Columbia University Press New York Guildford, Surrey Copyright © 1987 Columbia University Press Ail rights reserved Printed in the United States of America This book is Smyth-sewn. Book design by J.S. Roberts Contents Foreword Robert Coles vii Preface Franca Ongaro Basaglia xi Acknowledgm ents xxvii Editors' Note xxix Introduction The Utopia of Reality: Franco Basaglia and the Practice of a Democratic Psychiatry Anne M. Lovell and Nancy Scheper-Hughes 1 Part O ne DESTROYING THE MENTAL HOSPITAL: WRITINGS FROM GORIZIA Introduction—Nancy Scheper-Hughes 1. Institutions of Violence 2 . The Problem of the Incident 53 59 87 Part T w o DEVIANCE, "TOLERANCE," AND MARGINALITY: WRITINGS FROM ITALY AND AMERICA Introduction—Naomar de Almeida-Filho and Nancy Scheper-Hughes 3 . The Disease and Its Double and the Deviant Majority: Critical Propositions on the Problem of Deviance 4 . Letter from America: The Artificial Patient 95 101 127 Part Three PRACTICING KNOWLEDGE: REFLECTIONS ON THE ROLE OF INTELLECTUALS Introduction—Anne M. Lovell 5. Peacetime Crimes: Technicians of Practical Knowledge A Conversation with Jean-Paul Sartre 137 143 169 vi CONTENTS A Dialogue with R.D. Laing Science and the Criminalization of Need Part Four ON THE NATURE OF MADNESS Introduction—Anne M. Lovell 6. Madness/Delirium 194 202 227 231 Part F ive ANTI-INSTITUTIONAL POLITICS AND REFORM: ON PSYCHIATRY AND LAW Introduction—Anne M. Lovell 7. Problems of Law and Psychiatry: The Italian Experience Appendix: LawN. 180 8. Critical Psychiatry After the Law 18u 267 271 292 299 Notes 305 Foreword Robert Coles As I r e a d this book I kept thinking of one of the "psychotic" pa­ tients I met when a resident in psychiatry at the Massachusetts General Hospital in Boston. She was, by her own telling, sad and worried and fearful. She was also plagued by "ghosts," as she called them. The more I talked with her, the more I was con­ vinced that she was "delusional," that she was having "hallucina­ tions," both auditory and visual. I concluded that she was "schizo­ phrenic," and prepared to fill out a "pink paper"—that name we young psychiatrists-in-training used for the commitment form then in common use throughout the Commonwealth of Massa­ chusetts. I became brisk, efficient, determined; I was working in the emergency room of the hospital, after all, and there were oth­ ers to see—"alcoholics," men and women with various psycho­ logical difficulties (anxieties, fears), whom I would evaluate, and usually refer to the outpatient service. But this woman was really "sick," I concluded, and she needed to b