10.7340/anuac2239-625X-6062
application/pdf
2239-625X
6062
2
en
urn:nbn:it:unica-29870
John Foot
Anuac
Francesco Scotti, Per una storia della riforma psichiatrica in Umbria: Nascita ed evoluzione di una psichiatria di comunità in Umbria, Perugia, Morlacchi, 2021 (vol. 1, pp. 448), 2022 (vol. 2, pp. 506)
Text.Serial.Journal
https://ojs.unica.it/index.php/anuac
12
Book reviews
2023-12-31
2024-02-01
2023-12-31
2024-02-03
175-178
1
John Foot
2023/12/31
10.7340/anuac2239-625X-6062
175
University of Bristol, United Kingdom
2239-625X
2
178
urn:nbn:it:unica-29870
Francesco Scotti, Per una storia della riforma psichiatrica in Umbria: Nascita ed evoluzione di una psichiatria di comunità in Umbria, Perugia, Morlacchi, 2021 (vol. 1, pp. 448), 2022 (vol. 2, pp. 506)
https://ojs.unica.it/index.php/anuac/article/download/6062/5837
12
                                        2023 | Anuac. Vol. 12, n° 2, Dicembre 2023: 175-178




                                                                           Recensioni

Francesco Scotti | Per una storia della riforma psichiatrica in Umbria. 1.2 Nascita
ed evoluzione di una psichiatria di comunità in Umbria, Perugia, Morlacchi, 2021
(vol. 1, pp. 448), 2022 (vol. 2, pp. 506).




    Despite the extraordinary breadth and importance of radical psychiatry in
Italy in the Sixties, Seventies and Eighties, there has been too little critical
and historical work which has reflected on this complicated and fascinating
“movement”. Much of the material which is available has often been celebra-
tory, or merely descriptive. The monumental work of Francesco Scotti, when
added to that already published by the late Ferruccio Giacanelli, is the excep-
tion. It would be no exaggeration to argue that these three volumes provide us
with a full, open, detailed and critical account of the extraordinary role played
by radical psychiatry in the region of Umbria, from the Sixties onwards. Scot-
ti’s work has the great merit of openness – it never celebrates change, or pats
itself on the back, but rather analyses, discusses, questions and deconstructs.
As both the protagonist of the movement in Umbria, and its historian and
chronicler, it would have been easy for Scotti to exalt the vast progress made
by the movement in that region – in closing down repressive and damaging
systems of care for mental health and in opening up new institutions and sys-
tems. But this is never the way these volumes work.
    No other regional movement has taken this approach to its own history, with
the possible exception of Arezzo. These volumes represent a vast historical,
pedagogical, and psychiatric project – a narrative but also – crucially – a for-
ward-looking account which takes the story up to today, and is always open to
questions, to errors as well as successes, and to divisions debates and fissures
which also marked this movement. It is also a global account, not inward-look-
ing, but always looking outwards. This critical approach, like the meetings which
were held with patients and doctors during the “heroic” phase of the movement
within the asylum – is in the spirit of the movement it recounts and analyses.

This work is licensed under the Creative Commons © John Foot
2023 | Anuac. Vol. 12, n° 2, Dicembre 2023: 175-178.
ISSN: 2239-625X – DOI: 10.7340/anuac2239-625X-6062
176           Francesco Scotti | Per una storia della riforma psichiatrica in Umbria

   There is so much in here which is of interest, it is difficult to choose what
to discuss – so I will draw out some of the overarching themes which emerge
from the books. First, there is the asylum itself – the manicomio – in Perugia a
vast institution in both a physical and a medical sense, which dominated ev-
erything else. Scotti shows time and again how the asylum, despite the efforts
of the movement, was extremely difficult to “destroy”. Even when the radical
psychiatrists had moved onto mental health centres and decentralised care,
the asylum didn’t go away – and continued to absorb resources, energy, politics
– both in the city and the region but also in the minds and consciousness of
the general public concerning mental health and illness. Even when the psy-
chiatrists tried to ignore it, they were drawn back to it time and time. It took
decades for this presence to finally fade, and even now, it remains part of the
debate. One conclusion to be drawn from these books is how difficult it was
to move on from the asylum system, and how its power was embedded in the
health system and in the minds of those who had to deal with mental illness.
   A second key theme is the ferment of ideas, meetings, discussions, debates
and innovation, often discussed with global experts and thinkers, which moved
around the world of radical psychiatry in Umbria from the Sixties onwards.
This was a set of themes and problems which mobilised an entire region, and
which created new forms of institutions, of care and of thinking about mental
health. Of course, there was often discussion, and division, over the “correct”
path towards mental health – through society, through the family, through
the treatment of children. Which therapies, where, and how? Which kinds
of treatment? Who was to be treated? Who decided? These are all questions
which run throughout Scotti’s book and open up issues which are still relevant
today. Umbria in this sense had the distinction of always concentrating on the
resolution of problems, not on the creation of over-arching “theories”.
   A third theme lies in the increasing bureaucracy and its dead weight which
Scotti details, and critiques, in the latter parts of the volume. The proliferation of
acronyms and organisations, which Scotti treats with his usual sense of lightness
and irony, are a symptom of this problem. Rules, regulations and problematic
power structures have been imposed on systems which were marked by creativ-
ity and freedom. Judicial power, once liberatory in Umbria in the earlier stage
(in some instances) became more oppressive, as psychiatrists lived under fear of
criminal prosecution for simply doing their job or taking the risks they saw as
necessary in difficult, daily situations. Scotti’s use of stories and micro-histories
is especially effective here. Certain extraordinary personalities from the move-



2023 | Anuac. Vol. 12, n° 2, Dicembre 2023: 175-178
Francesco Scotti | Per una storia della riforma psichiatrica in Umbria          177

ment emerge with force from his account – Carlo Manuali, for example – who
has been more or less ignored in many studies of the Italian radical psychiatry
movement, but who was, undoubtedly, one of the most original practitioners
and thinkers around themes of mental health and society from that period.
   Scotti also details the role of politics, and of a series of reforms, including
what he refers to as Aziendalizzazione – the business-type approach to health
care. Here we are presented with a story of fragmentation, of a loss of au-
tonomy and freedom to experiment, and of – at times – a sense of a return
to the past – with patients being treated as a problem rather than with care
and attention, and the political system tinkering dangerously with a system
which had worked so well, and had been recognised not just in Italy, but also
elsewhere, as an exemplary set of institutions in terms of mental health care.
Here, we can see issues with the lack of coordination between services, and,
at times, the excessive use of forced treatment provisions which were adopted
so sparingly in the past, when the idea of “non-ricovero” was the over-arching
aim of all those involved in the system.
   Finally, these books also provide a rich social history of Umbria through
many of the stories and vignettes which Scotti recounts. Psychiatrists working
in the system in the period of change never saw mental illness in isolation, but
also in line with social context, the family, the territory. Factory work and con-
ditions could lead to forms of addiction and illness in themselves, and some
extraordinary examples of this are detailed in this book.
   On every page of these books I found something which was worth thinking
about and reflecting upon, so much so that I covered my volumes with pen
marks, questions, queries, notes to myself to follow up on certain points, and
bookmarks. This experience with all its richness, and with all its highs, and
lows, successes, and failures, experiments and tragedies, deserves to be stud-
ied by all those interested in what happened with mental health systems in
Italy (and the world) between the Sixties and the Nineties and beyond, and by
all those with an interest in mental health today. The danger is that this whole
period, this whole movement, this entire period of radical change, will be for-
gotten, and that the asylum will return – in another form, of course. These
volumes are also a warning, and an incentive, to stop this happening.

                                                                        John Foot
                                                              University of Bristol
                                                              j.foot@bristol.ac.uk



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