Festival dell'architettura

The hypothesis of a new space between Via A. Valerio and the S. Giovanni Hospital. 11/10/1985. Giovanni Michelucci sketch

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Abstract

In Italy and all over the world, Trieste has been a pioneer city for the radical transforming of institutions as well as of profound cultural wounds. The long process that led to the opening and later on to the closing of the San Giovanni psychiatric hospital has shown that it is possible to live while denying a neat separation between madness and normality. The return of the wonderful park to the city and the contemporary penetration of a network of facilities through the urban fabric are not only alternative practices to the inalienability of total institutions, but also a project that is bound to affect the everyday work on those walls, which keeps on stressing inclusions and exclusions.

Article Text:

“[…] Even if, we wish, medical science were able to extinguish the pains and the dramas of madness, the city would still need to remember, to embrace some issues that are closely related to the fool’s behaviour, i.e. to grow richer of a voice that, though formerly seemingly dissonant, would add a different and deeper meaning to what has been so far defined as the space of reason.”[1]

Giovanni Michelucci couldn’t help but being curious about what was happening in the first 1980s. The abandonment of psychiatric hospitals had begun, at first with eagerness, later on with slowness, finally with oblivion. Some exquisite buildings as well as large parks along the boundaries of cities were unveiled for the first time. A lot of us then wandered about the many beautiful things that could be done. Michelucci and his students were called to discuss about the psychiatric hospital in Como and then about the San Salvi’s in Florence. Some years later, almost a centenarian, he came to Trieste to ‘take a walk’ through the Basaglia experience of a closed psychiatric hospital. In a text that he published with some students of his, he thinks over his promenade in the park (while sketching and taking notes): “To our eyes this complex appears as some kind of ‘stone guest’ asking us about the ancient and the new history, the new one above all, of which the complex itself holds us accountable, a history that manifests in the long wait for something that is continuously deferring its arrival. A guest, one should add, who demands many explanations and gives little suggestions.”[2]

The reflections and the queries arising from these surveys, read again today, are very precious clues for understanding today “the end of the magnificent psychiatric hospital of Trieste”.

How to revitalize these days the extraordinary rich architectural heritage of San Giovanni’s hospital, how to keep alive the capability to go on querying about the nature, the care-taking and the institutions of mental disease, these are the issues the following text is bound to deal with.

The relationship between facilities for psychiatric care and architecture has a long and appealing story. From the second half of XIX century to the beginning of XX century, the limitless eagerness for scientific achievements and certainties, electricity, speed and new transport routes affect the realm of medicine. The progress of medical studies is marked by a succession of discoveries that elicit eagerness and expectations. Faithful to the positivist paradigm, physicians achieve definitions that are more and more certain, accurate and obsessive about the organization of institutes and provide the psychiatric hospital designers with detailed and scientifically indisputable instructions. Psychiatric hospitals spread all over the western world and overseas, along the routes to colonies: a real pandemic disease.

The topographic layout of wards, facilities, gardens, paths, surrounding walls, close surveillance pavilions as well as wings for mentally ill or calmer patients, if observed from above, as the magnification of a cell nucleus, would resemble a chromosomal map: the psychiatric institution genome.

Architects figure out and design complexes, which are amazing owing to their functional accuracy, precision of details and experimentation of the most advanced building techniques. Designers are successful in founding cities that embody the promises (as well as the false prophecies) of psychiatry and are separated and autarchic: places for care and custody, protection and detention. Those utopian citadels will soon disclose their real task: social control and separation of the mental ill from normal people.

Between XVI and XIX Centuries, the story of the madness institute in Trieste would broadly follow the European events. At the end of XIX Century the demographic growth of the city and the consequent increasing of mental ill people convinced the city government to start the building of the psychiatric hospital.

A consulting committee was established to study the state of the art of psychiatric hospitals in Italy, in Austria and in the rest of Europe: the result was that the most widespread typology was the integrated single block building.

On the contrary, the criteria chosen for the psychiatric hospital in Trieste were considered more updated: a sprawled complex, with pavilions spread all over a wide fenced area, with open gates in the surrounding walls and spaces for the work of sectioned patients (occupational therapy). The Magnificent Psychiatric Hospital, designed by the architect Ludovico Braidotti[3], was opened on November 4^th 1908.

In August 1971 Franco Basaglia was charged with the direction of the hospital. The model of the Therapeutic Community, developed in Gorizia during the previous decade, had achieved a wide national appeal following to the publication of L’istituzione negata[4] (The denied institution). For the first time that book denounced the conditions of sectioned patients and stated that psychiatric hospitals could not be reformed: it couldn’t fulfil such objectives as assistance and care, while obeying to rules and laws meant to public order and social control, since it was itself a disease-producing institution.

In Trieste it was necessary to follow the course that had been charted in Gorizia in order to go beyond psychiatric hospitals: i.e. transforming the institution not in order to reform it, but to overcome it by means of the construction of a network of territorial services, which are alternative and substitute of the many functions – care, accommodation, protection and assistance – deadened and actually denied and distorted in psychiatric hospitals.

On Decembre 31^st 1971 there are 1182 sectioned patients in the hospital. Since the first months in 1972 much attention is paid to organize changes of the interiors. Stiff professional hierarchies are challenged. Space is refurbished and organized as “open communities”. Patients are no longer divided according to their behaviour, but accommodated and grouped on the basis of their territorial origin. The hospital was divided into five zones, respectively related to five geographical areas of the city and its province. ‘External job’ starts and the bases for the forthcoming development of centres for mental health are established.

We started moving furniture. The rooms in the wards, then opened, though wide and bright, would keep on rendering misery, emptiness and melancholia. Following the opening and the more and more diverse frequenting, the stiff order, which furniture would help to guarantee inside the closed wards, was completely undermined. Furniture had then become just witness of the stillness and of the lack of care for the people, which that order had long concealed. Burning hopes and great expectations were in the air, so close to be felt. And then we kept on moving furniture, to change everything right then! One day we deployed armoires across the large dormitories, which hosted more than forty beds, trying to divide them in smaller spaces to favour some unlikely privacy. Some other times we rearranged the tables in the dining-rooms and the furniture in the sitting-rooms to let people achieve a higher autonomy in fetching and eating their meals, and to create more comfortable and friendly meeting spots.

The previous year, the controversial flight of Marco Cavallo[5] had denounced the real life conditions of medical staff and sectioned patients. Basaglia had demanded for urgent refurbishment and new furniture, which were finally approved by the Provincial Council. Almost all the old wooden furniture was thrown away, and the new Bergamin furniture was bought. Colourful and avant-gard designed furniture: apple green or dark brown four-seat and six-seat dining tables, comfortable chairs and arm-chairs of the same colour and a very funny, round-shaped, brilliant orange arm-chair. And finally in the bed-rooms, night tables, one for each bed, and lockers.

Thus we kept on moving furniture. Now in an increasing heat and hope. We’d better abandon the hospital and work outside. Nevertheless we focused compulsively on the interiors. It become then clearer to us that we could not abandon the hospital. We had to manage and transform it, transform and manage it until it would become useless and unnecessary.

While the doors were opened, shock therapies and all systems of mechanical restraint had already been abolished. Also the separation between men and women was abolished, and the basis for the creation of mixed wards was prepared. The community life in the hospital livened up. The cafeteria, the social centre, the cyclostyled bulletin, the parties start peeping out. The number of trips out to the town increases.

In 1974 Spring Ornette Coleman showed up. It was the first time a concert, a jazz concert!, would take place in a psychiatric hospital. After so many hesitations the concert was held in the sport pitch the park. Since then and for the two following years, San Giovanni’s Hospital hosted musicians, actors, singers; all of them were attracted by the uniqueness of that kind of experience and meant to give their personal contribution to that strange “revolution”.[6]

The concerts in San Giovanni’s had been the opportunity for a lot of youngsters to learn to know the psychiatric hospital life from an internal point of view, and for the sectioned patients to get in touch with the external world. Posters, leaflets, bulletins print in the hospital testified the urgency of opening. The external world flew inside without filters and barriers and generated day by day a radical change of scene.

In June 1979, on the solstice day, the park hosted more than 5,000 people for the feast of San Giovanni’s/Svetoivanski kresovi’s bonfires, a traditional feast of the Slovenian community living in the neighbourhood: the midsummer night’s fires seem to burn the waiting time. Those fires stated the end of the psychiatric hospital and so many young people danced and singed until dawn, perhaps not completely aware of the historical change that was actually beginning that night.

The birth of the cooperative and of the co-living groups forced to observe people inside the social contract. The start of a deep and radical change became evident. It is useful to recall Michel Foucault’s bright lucidity, who knew Basaglia’s experience, and in a conversation about strategies of power writes: “in a nutshell, humanism consists in wanting to change the ideological system without touching the institution; on the contrary a revolutionary action is defined as a shock both of the conscience and of the institution […] (Microfisica del potere [Microphysics of Power], 1977).

Basic human needs, getting food, clothes and a house, which were guaranteed and at the same time denied by the institution, take now shape according to the peculiar needs of each single person. On one side basic human needs, on the other side radical needs: being free, desiring, choosing, constructing one’s own identity do arise in their full intrinsic urgency. A sole attention to basic human needs would achieve circumscribed value and meaning, once again reducing ones, as to confirm again the flatness of the condition of the mental ill.

The large halls of the first emptied ward were suitable to host an original workshop of painting, sculpture, theatre and writing. “Marco Cavallo” was born: a blu horse made out of timber and papier-mâché, expressing the desire for freedom of all sectioned patients. On the last Sunday in February 1973, the horse made a breach in the outer wall. A parade of medical staff, patients, artists and citizens, following the horse in the lead, swarmed out through the town. Since then, the horse has never stopped, and has become the story of the movement for the liberation from total institutions.

The work outside the hospital – through resistance, success and conflict – introduces the first and most meaningful changes in therapeutic practices and in the institutional structure, and becomes an extraordinary school camp for healthcare assistants and physicians (as well as citizens).

The first Centres for Mental Health were founded between 1975 and 1976, ahead of time with regard to Law 180/1978 and do develop in spite of the experimental nature of the project as well as of the uncertainness of legislative references.

While the psychiatric hospital management was still working, the territorial service network was expanding. Two cultural and organisational healthcare assistance models were living side by side, along with two different financial managements and two different leanings for the management of healthcare and staff. The risk was a paralysis. This critical crux was resolved with the choice to invest for enhancing territorial assistance, developing and strengthening Mental Health Centres, which were open 24 hours a day and became the cores of the whole service system.

Analogously, since the end of 1990s and later on with strong actions in the following decade, the Health Authority started a project for developing healthcare and social service throughout the territory. Healthcare Districts, which were 4 as the Mental Health Centres, were enhanced and enriched with ground-breaking incitements. The hospital was supposed to be distinguished owing to high and excellent professional actions, while reducing the number of beds. The local management was meant to be able to support and follow through citizens in their way through their disease and care, as well as their chance to live in their environment.

In Trieste, in those years, a new network flanked the mental heath service network. The development of district actions led to strategic interventions on smaller areas, social housing neighbourhoods, as well as in convergence with other institutions for urban regeneration projects and for enhancing living conditions. Thus, a kind of extension of the culture and practice of de-institutionalisation was actually made not only in the field of mental healthcare, but in the whole realm of medical science.[7]

Since the 1970s the vast architectural site was gradually returned to the city. These days there are many institutions and services in the former wards and pavilions: besides many faculties and offices of the University of Trieste, located in six pavilions, also the Department of Addiction Care, the Department of Prevention and the District Health Authority n°4 along with all its services, are located throughout the complex.

At present, three buildings are still used by the Department of Mental Health (DSM): besides the Direction Headquarters, a pavilion hosts the Service for Rehabilitation and Accommodation, the headquarters of Radio Fragola, a radio station of the community, the offices of some social cooperatives that collaborate with departmental programmes as well as Lister, a colourful tailoring workshop. The historical cafeteria/restaurant Il posto delle fragole is very lively and popular. The Department of Mental Health is a Member Centre of the World Health Organization for research and education in the field of mental health.

Many subjects and many activities are now steadily located in San Giovanni’s District, which keeps on holding its strong historical identity, being the location for cooperation, meeting, ex-changing. In the latest years, some memoranda of understanding between several institutions (Municipality, Province, Regional Government, University, Local Health Authority) have favoured the regeneration of this place that, owing to the refurbishment of the theatre, is showing its potential for multifunctional uses of the park.[8]

The park, which is today known as San Giovanni’s Cultural Park, has been endowed with a valuable and rich rose garden. More than 5,000 roses have been planted.

The Director, and former Director of the Department of Mental Health, Franco Rotelli’s[9] dedication and foresight has successfully completed this ambitious project.

Today the park, besides hosting services and institutions and thus being busy with hundreds people each day, had become the destination of touristic trips, owing both to its history and to the uniqueness of its rose garden. Bus n° 12 runs across the whole length of the park.

Opening the park to the public is actually an unprecedented action of mental disease prevention: a place, which was a death theatre, testifies now the chance of redemption.

It is not, as one could imagine, a memorial, and absolutely not a monumental memorial, it is in fact a continuous provocation to imagine the future, to joy of the real absence of walls, a real condition of co-habitation. What in the 1960s was just a dream, has been now fulfilled. It is no coincidence that young people, and not only students, are projecting and livening up life and future in the park.

“[…] in my position as an architect, I must cope with the distressing problem of translating a principle, which I do approve, into architectural space: this principle being that a clear boundary between reason and madness does not exist”.[10]

The distressing problem that Giovanni Michelucci glimpsed in the early 1980s is still the everlasting, wrongly faced and often unsolved question about what is to be done next.

Once the psychiatric hospital is closed, what will the practices, the techniques, the management of mental healthcare be? What will the places of healthcare be? And what will the chances to live in town be, for people experiencing mental diseases?

The psychiatric healthcare reform and the closure of psychiatric hospitals had brought people and stories, needs and relationships, contexts and everyday life back to the main scene, and had actually dismantled the old and new places of psychiatry. Thus, a design of some architectural space for mental health could only be made through the comprehension of the meaning of these steps and on the basis of the critical work of psychiatrists and architects about their knowledge, techniques and working contexts.

The centres for mental health, i.e. the keystones, the outposts of the communitarian system of healthcare and assistance, were supposed to become places of transit, squares, markets, and to stop claiming their being medical offices. Places meant to favour exchanges, meetings and mutual acknowledgments, and to host in a peculiarly careful way. Places that these days, more than yesterday, want to be inhabited not (only) by patients. Places that design, construct and take care of their inside, without losing sight of their outside. On the contrary, it is the obsessive attention to their outside that demands a care of their inside.

Between inside and outside a threshold is drawn, which defines the space of meeting, listening, helping, caring, according to some kind of continuity between people’s houses, neighbourhood streets and mental health centres. Designing and building a mental health centre means making that threshold actual, usable and liveable.

Franco Rotelli thinks of and defines this place as a market. “Common sense says: ‘a good service office is an empty one’. I believe that a good psychiatric hospital in an empty one, a good mental health centre is a full one. What happens from Thessaloniki to Montreal is that you can see (dreadful) full psychiatric hospitals and (wonderful) empty mental health or family therapy centres. In a good mental health centre, questions bundle up, cross over and multiply, same as what happens in a market. A good marketplace is one of the few places where the social body recognizes itself and exists as a whole, and it is hard for everybody to resist the charm of its (of both market and body) swarming; a place where one can achieve one’s identity through participation.”[11]

The key word seems to be welcoming. A welcoming place does not emphasize unfamiliarity, does not influence, doesn’t force to a rigid use of space, allows individual accommodations; doesn’t refer to one (single) use, i.e. healthcare. Same as when we arrive in a good hotel that welcomes us and makes us feel comfortable.

A psychiatry that is wholly inside the medical paradigm defines diseases, objects, behaviours, risks, dangers, and incurability: «the psychiatrist ends up having blind eyes and deaf ears». Deafness and blindness hopelessly affect everything. These days imagining and designing differing places means to completely dismantle the mere medical paradigm, wonder about the nature of disease, listen to the people who experience it, and finally find out that any care can only be made through relationships, contexts, and inside the city.

“[…] We have started to think that the walls that must be torn down, are the walls of all kind of healthcare: the walls of the relationship between hospital and territory, between primary care physicians and specialized practitioners, between universities, faculties of medicine, hospitals, local services. […] Once again walls must be demolished and existing resources must be enhanced. […] Today’s needs and rights are being recognized as individual, playing a leading role in one’s healthcare, being helped at one’s home, being considered as unique subject though in need of relationships. These days, proactive healthcare must be brought to peoples’ home. And this is to be done not only for psychiatric disease, but also for all chronic and chronic-degenerative pathologies. We need a local healthcare that is capable to gather all resources. […] Linking peoples’ resources to institutional resources: this is the great therapy to rebuild the city, a city that takes care, a city that is capable to satisfy our collective needs. Nevertheless, this city can satisfy collective needs only if its strength is not fragmented, if clans are no longer clans, if the walls between different forms of knowledge, different disciplines, different powers and realms are finally torn down.[12]

Since it showed up, in the second half of 1970s in Trieste, the mental health centre has been making actual the presence of the mental ill through the social fabric. Some kind of reconciliation: an endless and controversial sewing up. It is actually no sewing up, but a wholly brand new and peculiar experience. An unprecedented experience that is rich of mystery and ambiguity. After ages, psychiatric hospital wall fall down and madness flows again in the streets.

The social fabric deploys in order to embed the place of suffering and at the same time produces antibodies to isolate, circumscribe and expel, so that integration processes are controversial and discontinuous, and never linear. A fabric that is unsewn and re-sewn each day. In everyday life, in conflicts, in getting in touch with problems and needs, possible and practicable relationships are continuously discovered.

A place for welcoming and caring can’t help but living in an urban context. Nevertheless, it is not at all obvious that a place where people go to express their mental pain is situated in the middle of town. We must admit that that presence emphasizes a provocation, a thorn in the flesh, a sign of diversity that is not easy to accept. Today in Trieste, for example, we can say that social fabric has embedded the mental health centre and citizens’ critical thinking has grown so that you can hardly hear any local saying that the mental health centre is a “place of the psychic pain of the mental ill”, if at all they may say, in a vague and benevolent way, “over there at the mads’”, and they will easily walk across that place with no fear or caution. It may happen that a walker’s look crosses some ailing one with no distance or prejudicial difference.

Here’s Michelucci again: “[…] One architecture that could provide folly with a feeling of freedom, would actually bring an essential contribution to the city problems, as a whole, and above all a guarantee for families not to be locked in their drama; healthcare would, in this case, imply the breaching of house walls: an event even richer of design hypothesis then the gradual closure of psychiatric hospitals.”[13]

Biografy

Peppe Dell’Acqua, former Director of the Department of Mental Health of Trieste, is the Director of the publishing series “180 – Archivio critico della salute mentale” [“180 - Critical Archive of Mental Health”] since 2011. He is one of the founders and sustainers of the Mental Health Forum, and in 2014 he was awarded with the Premio Nonino [Nonino Prize] for his engagement in social policies for mental health.

Silvia D’Autilia is PhD in Philosophy at the University of Trieste, cooperates with the publishing series 180 – Archivio critico della salute mentale, and deals with the links between psychiatry and subject, madness and power.