Instituting on the threshold
How can a place where such horrible things happened in the past be today a space that triggers beautiful projects? This question, posed by a member of the social cooperative Agricola Monte Pantaleone while commenting the map of the Loony Bin of Trieste as it was built in 1907, clearly states the question of invasion that I want to address here, in order to challenge a dichotomic understanding that opposes institutional reproduction to institutional transformation and for affirming invasion as a practice on the edge between reproduction and transformation; but also, beyond change, a practice of transition and regulation.
A few words for a diagram of the trajectory of the Basaglian project: in Trieste, in 1971 there are 1300 inmates, to whom freedom and dignity are denied, on whom violence and torture are allowed. More than a hundred thousand across Italy. The only way out of the loony bin is death. In 1981, after the ten years with Franco Basaglia and his team and after the radical psychiatric reinvention they led, the Italian legislation granted to close all asylums; internment is forbidden; civil, social and political rights are recognised to the “loonies”. In Trieste the asylum closes for real and the Park of San Giovanni opens instead. Centres in each district of the city are open 24/7 with beds and open doors (to get in or get out) (Mezzina 2000). Since 1991 tens of social cooperatives are organised with the support of the Department of Mental Health as well as educational grants, community budgets, economic mechanisms of support. There are apartments, neighbourhood services, and mechanisms for family integration or for the independent life of users. Furthermore, in the general healthcare system, a series of services of local care and public health have resulted from the Basaglian invasion into the general medical practice, especially through community healthcare.
Today in Trieste one loses the way in a physical, social and mental place constituted in the last 40 years of struggles, through borders, stories, lives, practices, objects, places. Always plural struggles: for civil rights of the loonies, for the liberation of subjectivities, against marginalisation and stigma, for autonomy and independence, for the right to leave and to stay, for and against medicines, about knowledges and practices, on the status of the people and the places, to put or take away things, to disobey or write laws, to make and spend money. Always multiple bodies: the loon, the politician, the dreamer, the desperate, the activist, the doctor, the faithful.
This multiple and plural invasion of the welfare system poses a crucial question for our present: How can institutions contribute to constituting new possibilities for social life in the current crisis? It is not a matter of defining the welfare state in a descriptive or normative way, but of analysing and intervening transversally on the effect the state has on the life of the city and of engaging with the “instituting possibility” of challenging the molar logic of the instituted, and towards a new set of social interactions, within and through institutions, at different levels, but connected among themselves.
I have been trying to deal with this question of intervention through different words and different worlds. Invention, invasion, transition as well as Quito, Barcelona and Trieste have been the material and conceptual sites, if this dividing line can be drawn, for analysing and enacting a possibility of transition. The lens of invasion can be useful to look at the institutional space not just in molar terms, and therefore to imagine a practice of transformation of the molecular dynamics of the institution as a way of affecting its general functioning and of doing this in a durable way.
In the space opened today by the possibility of a radical management of welfare services and public policies at the local level, like in the Spanish municipalismos, it is necessary to transfer the instituent dimension of policies and practices on the thresholds of the public services.1
The intervention on the state cannot be just vertical - along a civil line of representation that intervenes on the state through norms and from there into the real society. The challenge is to link the critical practice to a material operativity. To put the general intellect to work for producing prototypes that can unbalance the serious gesture of the institution.
In this sense, I try to sit on the limit of the institution where it is possible to build compositional dispositives, the threshold where invasion can start, the place where transition can become irreversible. At stake is what are the procedures and protocols that can maintain open the space of the institution not just as a challenge of transparency, where those out of the palace can see what happens inside, but rather allowing a permanent invasion that institute new forms of doing. The materiality of the threshold can be the place to perform the claim of Henri Lefebvre for an ecological approach to the production of the city. It is the site from which to perceive and compose the city, becoming forces of urban production, contrasting the strategic production of public policies as imposed systems of significations that intervene “upon reality”.
This possibility of inventing another institutional practice, of affecting social life, is the site I investigate here, looking to the social healthcare services of Trieste, because the practices of healthcare in this city constitute a radical experimentation of participation not as a deliberative practice about what the state has to do, but as a practice that institute new ways for doing. In the words of one of the healthcare workers I am working with in Trieste, indeed, one of the distinguishing elements of the territorial practices of healthcare is the production of zero-level-threshold services. A space of contact with the state where the codification of “provision” and "service" does not exist, a place where everybody can access, seeking to address any need.
In the Microarea Programmes - a set of interventions in several vulnerable urban spaces in which healthcare programmes, social services and housing provision intersect and involve local social networks in the design of micro public policies of care - the role of the public worker is not prescribed through a series of limits and duties, through which the citizen is included: as part of the state, as the objective recipient of resources, attentions, benefits. On the contrary, the singular story constructs itself as a narrative, constitutes itself as a space - it could be a woman recovering from some medical intervention and living alone; she cannot walk properly, but does not want to stay in a rehabilitation house during that period. So the worker starts to imagine a series of resources that can be activated in response to the situation, through the public and social networks of the welfare state and the public institutions, as well as through the business and social network of the city. In order to do this, she has to deal with a series of tiers and protocols, permits and hierarchies, logics and values, and find her way through different agents, allies, tools.
In other words the production of provision happens on this threshold, as a device that destitutes and institutes a practice. In an informal conversation a worker in the Microarea states: "the threshold does not exist: the service is there, the space is there to be inhabited". The limit of the state is contested in a concrete way, through the production of thresholds of invasion that instead of individualising the citizen in relation to the state, constitute a collective ethos made of responsibility, reciprocity, inclusiveness.
A collective ethos that invades the state and challenges the stability of the previous institutional practice. The Microarea worker calls the social services of home support, actually she2 calls a specific person that may be more interested in finding a solution; through this contact, she can activate the youngsters of the "solidarity service", secondary school students that receive an municipal annual small grant to participate in local solidarity networks; they talk and agree to have a meeting with the woman and see how they can help; at the same time the network of local business can bring her the shopping, and the Microarea worker alerts the people who tend to the vegetable garden in her block, so that they will take her fruits and vegetables, and check on her in the morning. At the same time, the worker takes care of mediating with the Rehabilitation Service and of translating the professional practice of medical care in the complexity of the everyday life of the citizen: maybe the Microarea offers to use the doctor's tables in their office to host specific (and public) medical instruments.
The artificial limit between society and the state blurs through the enactment of these practices as does the boundary separating the individual and the social management of a problem, or said in other terms the social production of care. The threshold is a space where the process of care stops to be about one person and starts to be an assemblage of things, practices and affects, the site of the medical practices but also the limit of the institution. The threshold is the materiality of a doorsill and how it can transform the institutional limit into an open boundary. Entering outside and exiting inside, as was written on a wall in Trieste during the radical reform of the 1970s!
And actually this materiality of the threshold as an open boundary is a crucial dimension in the Basaglian history of Trieste. If one looks at the dismantlement of the pavilions in the 1970s and the constitution of 24/7 open centres for mental healthcare in the public services later in the same decade, but also at the constitution of cooperatives, the development of time-banks and mechanisms of economic support as early as in the legislative production of the destitution of the asylum, it is clear that the dismantlement of the total institution has been material, not symbolic.
The destruction of locks and the fences, renouncing to the spaces of the asylum, trespassing the doorway and constructing always-open institutional sites in the city was not only about destroying the peculiar repression of the psychiatric institution. It was about breaking apart the institutionalisation of life built through the production of healthcare as a system, and of medicine as knowledge. The destruction of the place, Franco Basaglia says, is the limit to be inhabited in order to produce another place together: with the inmates, with the workers, with the nurses. It is not about abolishing a fence, it is about destroying it, in the most material sense. The radical deinstitutionalisation of the Trieste Psychiatric Hospital in the 1970s is in the first place a practice of violence, a re-appropriation of the risk of the incident by those to whom is denied their ability to act, the responsibility of actions, confined in the realm of the “force of things”.
In the Basaglian conception of the institutional transformation, the problem of management is the problem of incident, in the sense of how to break apart the constrains that limit the responsibility of the users, but also of how to make this freedom something durable and sustainable. Famously commenting on Frantz Fanon’s resignation letter from an Algerian mental healthcare department, Franco Basaglia affirms that in a time in which the revolution is "for obvious reasons" not possible, "we are forced to manage an institution that we deny”.
The impossibility of revolution is an institutional impossibility: in dealing with the suffering of the people detained in the asylum, deinstitutionalisation cannot be a practice of destruction followed only in a second stage by new production. In the words of Franco Basaglia, the US therapeutic community following the radical critique of Erving Goffman has produced market, class, individualism: "abandonment and misery". In England, the antipsychiatric movement "has left people behind", those unable to escape the public institution and participate in the communes of Ronald Laing and David Cooper (Crimini di pace, cf. Guattari in Molecular Revolution).
On the contrary the question is how to destitute and institute, destroy and invent. Destroying the asylum and madness as institution, but also being capable of preserving a series of capabilities of the institution. The Trieste psychiatrist Giovanna del Giudice talks about these rights to refuge and asylum as a collective attempt of taking space to constitute a social practice of emancipation. Inventing the institution as a social organisation of knowledges, instruments, resources, places and times, immersed in urban life and capable of supporting this process, in the constitutively difficult freedom of urban life (Mariagrazia Giannichedda in Basaglia 2005).
"Perceive and compose" the city, would be the Lefebvrian way of putting it. Indeed, on this limit between violence and management, Trieste poses the question of change in a series of political and ethical relationships that are directly urban, because destroying the institution is not enough if another invention does not inhabit and compose a new place, where the former has been destituted.
This is the case of the park of San Giovanni. The park opens where the asylum closes and populates this institutional invention through the complex intertwining of different life-forms and initiatives: not only the University, the Healthcare system and other public institutions, but also cooperatives, plants, festivals, benches, campaigns, associations. The ecology of the park grows and invades in a wider urban political ecology, because it is immersed in the ambivalence of urban life, in the difficult freedom of the city.
The park is again a threshold where both nature and the city are always present, earth and contracts, gardeners and water, saws and lovers and five thousand roses: “but five thousands roses are still missing, and they are for me the sign of the city that is uncertain, they are the cypher of what is possible, of what has not become true in that true life that we wanted to live, for us, for the loonies, suffering brothers and sisters with whom we have done a long walk. A walk that took us far, but not as far as we hoped we would get (but much more far way than their lordship could even imagine). The rose that still does not exist calls for another time, another generation, another energy, another love. Of which no one for sure can today, especially today, make any prophecy: a prophecy done of men and women that can look, and listen, and watch, and touch, and smell, and use their all senses, and cultivate the concrete signs coming out of them: because capable of listening the rumour of life, and touching the earth, and watering the roses, and changing the things.” (Franco Rotelli, 2015)
In the invention of this five thousands roses "to come" there is another dimension of the threshold that I would like to address here: a temporal threshold that is at the same time a challenge against the inevitable future and the possibility of an irreversible transition. In other terms there is an ambivalent dynamic between transformation and durability: the ability of making the traditional practice unstable and the possible transition durable.
Today this is the struggle happening around a series of protocols and practices, rules and laws: it is not only the attempt of producing a new Italian law for mental healthcare and, at the local level, a regional law that affirms a social understanding of care and health, determining obligations in the definition of budgets, and a profound reorganisation of the healthcare system in general. This is also a struggle around protocols and mechanisms to integrate and intertwine social and healthcare services with social practices, local networks, community dynamics and all the contradictions these practices bring. What really matters is how these laws and protocols can affect the threshold, how they can change the effect of the state on the doorsill of the Microarea where the institution becomes molecular, where workers, users, citizens meet, invent and act in connection with a series of tools, through a catalogue of practices, according to a series of protocols. In the words of Franco Rotelli, the attempt is never the one of making the institution an utopian place, the space itself of emancipation, but rather to think how the different and ambivalent practices of those who live within and through the institution can contribute to strengthen a social practice of emancipation. How to support, strengthen, and enrich the social autonomous reproduction of a city that can heal and care.3
Franco Basaglia/Franca Basaglia Ongaro (Hg_innen.) (1975), Crimini die pace. Ricerche sugli intellettuali e sui tecnici come addetti all'oppressione. Torino: Eunadi.
Maria Grazia Giannichedda (2005) in: Franco Basaglia, L’utopia della realtà, hg. v. Franca Basaglia Ongara. Torino: Eunadi.
Félix Guattari (1977/1984), Molecular Revolution: Psychiatry and Politics. London: Penguin Books.
Roberto Mezzina (1997/2000), The Trieste Mental Health Department: Facilities, Services and Programs. http://www.triestesalutementale.it/english/doc/mezzina_2000_trieste-mhd.pdf.
Franco Rotelli (2015), L'istituzione inventata/Almanacco Trieste 1971-2010. Merago: Edizioni Alphabeta.
2 The great majority of the people participating in the care-teams of Microarea are women, including workers, citizens, users and other participants.
3 I have been dealing with these issues also in: L'Internationale online blog, http://www.internationaleonline.org/people/pantxo_ramas.