The Mad Hatter – presents a conversation with Dr. Giorgio Antonucci

Il Cappellaio Matto – The Mad Hatter – presents a conversation with Dr. Giorgio Antonucci

Italian group of users and survivors Il Cappellaio Matto is happy to share an extended interview with Giorgio Antonucci, physician, psychoanalyst, and director of two mental hospital wards for many years.
He fought to prevent and abolish forced psychiatric treatment, to the liberation of people from Italian mental hospitals from the early 60s onwards and above all to demonstrate that a psychiatric diagnosis is in reality a psychiatric judgment, supported by a social prejudice.
The first of eight instalments of the interview can be seen here:
It is available with English language subtitles thanks to the efforts of Il Capellaio Matto.
That’s the first publication in a foreign language , except a book in Danish: Svend Bach, a literature professor at the Aarhus University, dedicated him: Antipsykiatri eller ikke-psykiatri.
Giorgio Antonucci began his job as a physician in Florence (Italy), trying to solve the problems of people who risked to end up in psychiatry. He began to engage himself in psychiatric problems, trying to avoid hospitalizations, internments and any kind of coercive methods. In 1968 he worked in Cividale del Friuli (with Edelweiss Cotti), a public hospital ward, the first Italian alternative  to  mental hospitals. In 1969 he worked at the psychiatric hospital of Gorizia, directed by Franco Basaglia; he criticised the fact that in this hospital electroshock was taken away only for men, and continued to exist for women. (It is to taken in account, that Basaglia was away most of the time, for conferences and so on, then he died at 56 in 1980). Antonucci said that of course Basaglia was the first who took under question the mental hospital and that he rightly said that it was (is) a matter of class. But Basaglia did not go all the way down to say that the mental hospital is a prejudge in itself, not only a building, and he spent his time with conferences all over the world and writing books, articles etc. Antonucci indeed was working every day with the patients, to give them back their freedom.
From 1970 to 1972 Antonucci directed the “Mental Hygiene Centre” of Castelnuovo nei Monti in the province of Reggio Emilia. From 1973 to 1996 he worked as head physician in two mental hospitals of Bologna, Osservanza and Luigi Lolli, dismantling some psychiatric wards and setting up new residential opportunities for former inmates, giving them complete freedom of every personal choice. A successful example unique in Italy and probably in the world. From a political and religious point of view he is an anarchist, libertarian and atheist.
“Forced treatments are violations of their rights and harmful to them, to their thoughts and their lives, therefore I started dealing with psychiatry”, he says.
In this short conversation with the actor and activist Saverio Tommassi, Antonucci discusses the difference between genuine systems of healing and psychiatry as a way of social control, “a moralistic judgement and the claim to control the behaviour of those who don’t respect social conventions”. He explains the genesis of his own opposition to all forms of psychiatric incarceration, restraint and forced drugging: as a young doctor, he witnessed the lock-up in asylums of women considered “difficult”, who had once been prostitutes, and been labelled as mad by Catholic authorities. He soon grasped that 90% of the occupants of institutions were the “socially undesirable” – homeless, disaffected housewives, unemployed, etc: “Inside the mental hospitals, it wasn’t mad people who were locked up – as it’s usually believed – but unlucky people who happened to find themselves in hard situations”.
“I think that often, in addition to the hazard of psychiatric opinion, the most dangerous thing is when a person resigns to his own conviction of being sick” .
Dr. Antonucci has never made a forced treatment or forced hospitalization, and has never prescribed psychiatric drugs, because, he said “as a doctor I did the Hippocratic swear to never harm a person”.
Later, Antonucci describes the “calate”, mass expeditions of Italian citizens to state psychiatric wards to see exactly how inmates were treated: “It was a cause of great disgrace to the doctors because people, including children, were found tied up to chairs or to beds and locked up inside little rooms. And so for the first time, an entire population made up of peasants, local authorities, workers, county mayors, even a parliamentary deputy all brought into question the asylums as an institution”.
Giorgio Antonucci’s language is always very simply, without difficult words because he says that his words have to reach all people.
Dr. Giorgio Antonucci believes in the value of human life and he thinks that communication, not enforced incarceration and inhumane physical treatments, can help a person in difficulty – if the person wants to be helped. In the institution of Osservanza (Observance) in Imola, Italy, Dr. Antonucci treated dozens of so-called schizophrenic women, most of whom had been continuously strapped to their beds or kept in straitjackets and lobotomized with psychiatric drugs. All usual psychiatric treatments were abandoned, also psychiatric drugs, unless a person wanted to continue to take them. Dr. Antonucci released the women from their confinement, spending many, many hours each day talking with them, in order to establish a communication. He listened to stories of years of desperation and institutional suffering.
He ensured that patients were treated with respect and without the use of psychiatric drugs. In fact, under his guidance, the ward was transformed from the supposed most violent in a self-managed ward. After a few months, his “dangerous” patients were free, walking quietly in the garden and in the city streets. Most of them were discharged from the hospital and could go back to their families, but if someone wanted, could stay there, and was given two keys: one for the front door and the other for his own room. Afterwards, many of them had been taught how to work and care for themselves for the first time in their lives.
Dr. Antonucci’s major results also came at a much lower cost. Such programs constituted a permanent testimony of the existence of both genuine answers and hope for the seriously troubled.
Dacia Maraini, one of the most famous Italian writers, in an interview with Giorgio Antonucci wonders why, given the good results obtained, the same isn’t done in other wards: “First of all because it is very tiring – answers Antonucci with his quiet voice, – it took me five years of very hard work to restore confidence to these women; five years of conversations, even at night, of relationship face to face. This is not a technique, but a different way of conceiving human relationships.
“What is this new method which concerns the so-called mentally ill”? asks the writer. “For me it means that the mentally ill does not exist and psychiatry must be completely eliminated. Doctors should only treat body diseases. Historically in Europe psychiatry was born in a period in which society was organized in a stricter way, and it needed large displacements of manpower. During these deportations, under hard and hostile conditions, many people remained disturbed, confused, no longer produced goods and so there was the need to set them aside. Rosa Luxemburg said: “With the accumulation of capital and the movement of people, the ghettos of the proletariat widened”.
In the 17th century when the absolute monarchy (the State) takes form in France, the asylums were called “hospice places for poor people who annoy the community”.
Psychiatry came next, as an ideological cover. In Bleuler’s psychiatric treaty, the inventor of the term schizophrenia, it’s written that schizophrenics are those who suffer from depression, who stand still or obsessively run around the courtyard. But what else could they do so as inmates? Finally Bleuler concludes unintentionally comically: “They are so strange that sometimes they look like us”.

Bonnie Burstow on Call to Action

reposted from BizOMadness blog, written by scholar and activist Dr. Bonnie Burstow

The CHRUSP Call to Action and Its Significance

Various instruments of the United Nations have commented on forced treatment, or involuntary confinement, or both (for details, see Burstow, 2015a), and a number of truly critical additions to international law have materialized. Arguably, the most significant of these is the Convention on the Rights of Persons with Disabilities (see http://www.ohchr.org/EN/HRBodies/CRPD/Pages/ConventionRightsPersonsWithDisabilities.aspx). What makes it so significant? For one thing, because this landmark convention puts forward nothing less than a total ban on both involuntary treatment and the involuntary confinement of people who have broken no laws.

To highlight a couple of relevant passages, article 12 of the CRPD states, “State parties shall recognize that persons with disabilities enjoy legal capacity on an equal basis with others in all aspects of life.” Correspondingly, article 14 states:

State parties shall ensure that people with disabilities, on an equal basis with others:

  1. Enjoy the right to liberty and security of the person
  2. Are not deprived of their liberty unlawfully or arbitrarily … and that the existence of a disability shall in no way justify a deprivation of liberty.

What is likewise significant, the guidance provided clarifies that the ban on forced treatment and on voluntary committal is to be seen as absolute (see http://www.ohchr.org/Documents/HRBodies/CRPD/14thsession/GuidelinesOnArticle14.doc).

What we have here in other words is nothing less than a colossal breakthrough.

In line with the CRPD breakthrough, CHRUSP (Center for the Human Rights of Users and Survivors of Psychiatry) has issued a call to action in support of the prohibition (see https://absoluteprohibition.wordpress.com/). I strongly support this campaign both as a human being generally and as a psychiatry abolitionist—hence this article.

First let me say that whether or not one is a psychiatry abolitionist, or to put this another way, whether one sees some value in psychiatry’s tenets and approaches or whether one regards them as both totally foundationless and inherently damaging, there is an onus upon us simply as human beings to find a way to support campaigns of this ilk. When basic rights such as the right to decide what does or does not enter one’s own body and the right not to be confined to a locked ward are at issue, we all of us have a moral obligation to do something to set the situation right. How can it be acceptable to override people’s right to make decisions for themselves?  To stop people from walking about freely—especially when they have broken no law? Nor can the deprivation of such rights be warranted by claims (what follows are several of the standard ones) such as the person lacks the capacity to make decisions for themselves or they are of danger to self or others. As noted in Burstow (2015b), while for sure people may need assistance in making decisions, incapacity per se is a circular institutional construct; and besides that it is indefensible to deprive people of freedom on the basis of prediction, the elites involved in such decisions (read: psychiatric professionals) have virtually no ability to predict dangerousness. Nor for that matter do others.

The long and the short is that the cause is just, liberation from oppression is at issue, and irrespective of any differences in our respective understandings of psychiatry, there is ample reason for us all to place a priority on the current campaign. I am accordingly enthusiastically joining with leaders like Tina Minkowitz (see http://www.madinamerica.com/2016/01/campaign-to-support-crpd-absolute-prohibition/) in urging people to get involved.

That noted, while the campaign in question places a very special onus on all of us, and my major purpose in this article is to support that, I did additionally want to do what no other writer to date has done—to tease out the special meaning that the CRPD and such campaigns uniquely hold for those of us who are abolitionists, whether inadvertently or otherwise. What is especially apropos here is the attrition model of psychiatry abolition.  So what is the attrition model of psychiatry abolition? And as an attrition model abolitionist, how do I understand the current campaign?

Predicated on the understanding that psychiatry abolition is a process and a direction as opposed to a goal which can be quickly attained, the attrition model of psychiatry abolition, as articulated in Burstow (2014) and adopted by Coalition Against Psychiatric Assault (see https://coalitionagainstpsychiatricassault.wordpress.com/attrition-model/)

is a model for determining what actions and campaigns to support and what to prioritize. An operant principle is that active support be predicated on the capacity or tendency of the action or campaign to move society in the direction of abolition. Pivotal to the model are the following defining questions:

1)    If successful, will the action or campaigns that we are contemplating move us closer to the long range goal of psychiatry abolition?

2)    Are they likely to avoid improving or adding legitimacy to the current system?

3)    Do they avoid widening psychiatry’s net? (Burstow, 2014, p. 39).

Now again, while supporting the CHRUSP call to Action is urgent and necessary for the reasons already indicated, the degree of prioritization for an attrition model abolitionist would depend on the answers to such questions. So are there “yes answers” to the questions above? Let me suggest that albeit to varying degrees, in all three cases, yes.

To tackle this one by one, beginning with the first question, any measure which abolishes any integral aspect of psychiatry without question moves society demonstrably in the direction of abolition. Hence the prioritization by Coalition Against Psychiatric Assault, for example, of the abolition of certain “treatments” (e.g., ECT). And does this campaign target the abolition of anything integral to psychiatry? Obviously yes—all use of force and coercion. As such, the first criterion is satisfied.

Which brings us to Question Two: Is the campaign likely to avoid improving or adding legitimacy to the current system? This is the most ticklish of the questions, for a case could be made that the psychiatric system would be improved by becoming less coercive. This notwithstanding, my sense is that eliminating the coerciveness in no way constitutes an endorsement of psychiatry and could in fact function in the exact opposite way—that is, it could lead people to ask themselves: What else should go? It could even in the fullness of time, culminate in a more wholesale questioning of psychiatry—especially once it is seen that eliminating coercion can be accomplished without a plethora of horrid consequences following.

Finally, Question Three: Does the campaign in question avoid widening psychiatry’s net (translation: Would the campaign, if successful, avoid enabling psychiatry to scoop up ever more people?)? Here the answer is a resounding yes. The point is that were this campaign successful, not only would it not widen psychiatry’s net, it would demonstrably narrow it, allowing all those who say “no” to escape psychiatry altogether.

What follows from this analysis, this campaign is in line with abolitionist principles.  And as such, prioritizing this campaign is a natural move for abolitionist groups to consider.

Summarizing Remarks, Invitations, Suggestions, and Warnings

A very important move has been taken by the United Nations in the passing of the CRPD. For the first time in history, there is an international legal clarification that psychiatric survivors must enjoy the same rights as everyone else—that is, force is absolutely prohibited. This is not just “any” organization taking this position, additionally—this is a mammoth mainstream organization which wields both moral and legal clout. Correspondingly, an important campaign is now under way to support the absolute prohibition that is part and parcel of the CRPD. What has been shown in this article is that the prioritization of this campaign makes sense both on a fundamental human rights level and additionally, on a psychiatry abolition level. Given the prestige of the United Nations and given that many countries have already signed and even ratified the Convention, moreover, explicitly wedding this campaign to the Convention itself is itself pragmatic.

My hope is, correspondingly, that many embrace this campaign and join us in actively promoting it. Please consider contributing articles and pictures to the CHRUSP website. Please talk to others. Perhaps create educational events. If your country has not signed the Convention, not ratified the Convention, has added a restriction, or is simply in non-compliance, you or your group might want to take the lead in making the problem known. We have a moment for change here—and my hope is that enough people will face whatever fears stop them and reach out and grab it.  Not that winning this fight will be easy, for countries have a habit of ignoring/evading international law, including contractual obligations which pertain by virtue of being signatories to a convention. All the more reason to double and triple our efforts.

The biggest obstacle that we are likely to encounter is people’s fear of dangerousness. Be prepared to address it. Arguably, the second biggest is people’s sense that vulnerable folk are going to be deserted. A point to be made when talking to others is that the CRPD is clear that supports must be offered. And indeed, if we go about this correctly, the era of the CRPD could well become the era when an unprecedented number of new and exciting support options materialized for people—and, of course, voluntary ones. In this regard, contrary to the common and I would suggest duplicitous equation of psychiatry and services, and besides that “service” and “coercion” are more or less mutually exclusive categories, is not the stranglehold exercised by psychiatry itself one of the principal factors responsible for the paucity of services?

In ending, to comment briefly on a snag. Were this campaign successful—and yes, it is for sure an uphill battle—psychiatry’s likely response will be to step up its misrepresentation of its “treatments.” The point here is that the future of psychiatry would then be more dependent on personal buy-in; and as we know, institutional psychiatry, alas, has virtually no qualms about misrepresentation.

Now some may feel that this last point is a “red herring” or minimally a minor issue since the CRPD explicitly specifies that “informed” consent is necessary. To be clear, indeed it does, but so does almost every piece of “mental health” legislation in the world and that has had no impact whatever on the ongoing and ever expanding production and dissemination of psychiatric misinformation. Ironic though this may seem, the upshot is that in the event of success, stronger monitoring of and stronger reins on psychiatry would be absolutely necessary.

A conundrum to be sure, but hardly one that we have not encountered before.

References

Burstow, B. (2014). The withering of psychiatry: An attrition model for antipsychiatry. In B. Burstow, B. LeFrançois, & S. Diamond (Eds.), Psychiatry disrupted (pp. 34-51). Montreal: McGill-Queen’s University Press.

Burstow, B. (2015a). Canada—A Human Rights Violator (see http://bizomadness.blogspot.ca/2015/09/canada-human-rights-violator.html)

Burstow, B. (2015b). Psychiatry and the business of madness: An ethical and epistemological accounting. New York: Palgrave.