Technicians of the soul

This dissertation is about an episode in the development of Italian national mental health policy. Specifically, it focuses on what is called the Basaglia reform as it unfolded in the small city of Capua, in the region of Campania, southern Italy. These events began with passage of the second psychiatric law, known as law 180 (1978). By provisions of that law, Italy would become a country without asylums, where mental patients were no longer regarded as dangerous or unwanted outcastes. After passage of the new law, however, Italian psychiatrists discovered that change was to be a long-term process. They realized that effective practice did not result from a single set of codified, nationally enforced standards but needed to be culturally specific to each local moral world. The focus of this dissertation is the idea of psychiatric practice as a process of culture-making (the "culturo-poetic") as consciously articulated by local practitioners in the city of Capua. According to the Capuani, the conventional asylum was very much a replica of local culture. Thus, to better care for patients, it was essential that the local culture be transformed in two ways. First was an attempt to mobilize the cultural value of good upbringing ( educazione ). This process began by training staff members to hear and understand the underlying structure of intelligible noises and gestures produced by people suffering from mental disorders. Patients, once dismissed as the aberrant ( diversi ) could now be treated with respect. Second, Capuan psychiatrists acknowledged the changing medical environment of today's world. Though new psycho-pharmacological tools might help reduce or even eliminate symptoms, it did not reduce the number of psychiatric patients. Moreover, the practices sanctioned by law 180 together with the impact of the new medications served to undermine the traditional roles of family, school, and parish church in restoring health. This made patients even more dependent on physicians. To confront this phenomenon, psychiatrists in Capua attempted to create a psychiatry of engagement ( psichiatria di collegamento ). It aimed to restore the competence of traditional social institutions as well as to impart teaching of the new psychiatry to medical practitioners generally.