The Basaglia Experiment.

Last month the denizens of Dublin celebrated “Bloomsday” an annual celebration of their once exiled son James Joyce and his misunderstood classic novel “Ulysses”. As the years have passed Irish people have rehabilitated the man and his literary reputation. When once he was a figure of disgrace, now he is part of the history of Dublin. No-one can forget his paean to the city and its people in his short story collection entitled “Dubliners”.

However as a young man he was ambitious and utterly convinced of his own genius, and it seemed that his ego was too large to be accommodated in Ireland. At 22 he moved to the Continent in an attempt to begin a new life as an aesthete, free from the shackles of convention and polite Irish society. This was a society dominated by the influence of the Catholic church and its dogma, which in Joyce`s eyes prevented the development of free thinking, both intellectually and artistically.

Joyce worked as a language teacher in Trieste. He found himself at home here because it was a modern cosmopolitan city and a beacon for artists and writers. He was accompanied by his great love, Nora Barnacle and their two children Giorgo and Lucia. Lucia was a sickly child and unused to the many upheavals and changes in fortune owing to her father`s literary career.

Lucias adolescence was marked by insecurity and mental instability. Some people, including her own father believe that this was inherited. However this is a moot point. Joyces literary work is characterized by grandeur and sometimes linguistic impenetrability but he could not be classified as mentally ill. Lucia in contrast began her life in a pauper`s hospital and struggled with her health in early infancy. She was also born with an eye condition which made her appear cross eyed . She had a famous dalliance with Samuel Beckett but it abruptly came to an end. She also had a fervent hope that she could become a professional dancer but failed in her endeavor. Then she developed schizophrenia and spent most of her life in psychiatric institutions. She died in a Northampton asylum in 1982.

Ironically it was a pioneering psychiatrist from Trieste who sought to change mental health care and the perception of psychiatric patients. Dr. Franco Basaglia devised a more humane system of treatment focusing upon the individual patient. He found the regime of restraint and confinement distasteful and counterproductive to the patient`s recovery.

His ideas became part of a more modern approach to treat psychiatric patients but it took time for these to become accepted by his peers. However these radical approaches began to filter through and spread beyond the medical establishment in Trieste. These new ideas even influenced health policy here in the UK. Enoch Powell was an unlikely advocate when he was health minister in 1960. His “Hospital Plan” to modernize the Psychiatric Hospitals did not come to fruition, however.

Twenty years later Powell`s plans (inspired by Dr.Basaglia)came back into favour. “Care in the Community” became official policy in 1983, too late for vulnerable people like Lucia Joyce, but a sign that mental health issues should not be hidden away or become a source of shame for patients and their families. For decades family members were banished to asylums and rapidly became institutionalized. The effects of this were horrific, gradually the person they loved would disappear in a recognized side effect of institutionalization known as “depersonalization”.

The new policy modernized the psychiatric hospital. Patients were allowed to wear their own clothes,often had a room to themselves and would only stay as in patients during the acute stages of their illness. Then they would be encouraged to adapt to the outside world through therapy provided by out patient services. Staff at these units also would wear their own clothes rather than uniforms. Gradually patients could recover this way before returning to the community rehabilitated. Thankfully the Basaglia project has made mental health services more humane and allowed us to turn away from the bad old days of the institution which ultimately failed luminaries like Lucia Joyce and her fellow travelers.

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