We are inside Parco di San Giovanni, in Trieste.
In the 1970s this place was the epicenter of a revolution
hat completely changed the field of psychiatry.
Many countries around the world, 
including developing and industrialized nations,
still look to Trieste as a model of reform.
To understand how all this came about,
we need to go back in time…
At the end of the nineteenth century,
and the early twentieth century, Trieste
- still part of the Austro-Hungarian empire -
experienced an influx of immigrants.
Trieste’s population rose from 104,000 inhabitants
In 1859 to approximately 230,000 in 1910.
The surge in population led to increased poverty, social exclusion,
and mental disorders in increasingly
wider sectors of the population.
As the population became increasingly unstable,
it became necessary to open a facility
to restore a sense of balance and security in the city.
Trieste’s goal was to build a modern asylum,
along the lines of the "open door" system
implemented in Central and Northern Europe.
The asylum was inaugurated in 1908,
based on the Austria’s model 
of individual pavilions,
arranged in a large green space,
with a church, a theater and a workers’ village,
creating a replica of a “normal” city,
and hence, a normal life on a smaller scale.
When Trieste became part of the Kingdom of Italy,
the asylum was subjected to Italian laws.
Over time, the facility began using practices,
such as bed restraints, strait-jackets
and electroshock therapy.
The park was surrounded by walls,
and patients were reduced to prisoners:
they weren’t allowed to leave the pavilions
or see relatives,
and their political and civil rights were denied.
They lost any semblance of a normal life,
and over time, their self-determination was eradicated.
Patients became apathetic,
and human contact was virtually abolished.
Dialogue between patients and nurses ceased,
and the behavior of caregivers
bordered on the conduct of prison guards.
Now, let’s see what the layout of the park looked like…
The park was divided into three areas:
the lower section was the freest area,
and the one most open to the public.
A variety of hospitals were located there.
Among them was the Ralli Pavilion;
one of the most significant.
Orphans, and children with various diseases
were treated here, 
and remained up to the age of 14,
when they were either reintegrated into society or,
as often happened,
moved to the therapy department
without ever seeing the outside world. 
The therapy department was located in
the second area of the park 
where the clinical departments were located.
The pavilions were symmetrically arranged,
and divided by a central avenue
separating the men's buildings from the women’s. 
As one progressed along the avenue,
therapeutic practices became more and more serious
according to the patients’ diagnoses.
As one reached the northernmost area,
alongside the worker’s village,
patients were given the opportunity to move about
and work in the asylum in accordance with the 
precepts of ergotherapy
- a therapeutic method for mental illness
that was supposed to cure patients by means
of isolated work activities.
Internment was used as the main means
of therapy throughout most of the twentieth century,
until 1971, when Franco Basaglia,
an Italian psychiatrist and reformer,
opened the doors to the asylum
and  revolutionized the mental health system in Italy.
Franco Basaglia was a psychiatrist and neurologist of Venetian origin,
who was responsible for transforming the field of psychiatry in Italy.
He had strong nonconformist ideals,
and fought against oppression from an early age.
He was even jailed for a several
months for his anti-fascist activities.
Doctor Basaglia began his career
in the field of psychiatry in 1961,
when he became director of the
asylum that had been located in Gorizia.
It was his first time in a psychiatric hospital.
The odors, the patients’ moaning voices,
and their apparent despair had a
profound effect on him.
The experience completely
shaped his approach to psychiatry.
From that moment on, Basaglia knew
there could be no real treatment for mental health
disorders without a drastic reform.
Internment, as the only method of treatment,
had led to alienation and made it impossible to identify
the nature of a patient’s problem,
which might simply be the result
of social unease and marginalization.
Although patients have the right to maintain
their independence and dignity,
which is taken for granted and 
constitutes the basis of treatment,
it was Basaglia's work that dramatically
changed the mental health care system.
In fact, Dr. Basaglia focused his entire career
on attempting to restore the patients’’ dignity,
as well as their civil and political rights.
Their right to be self-determined was reinstated,
and control over a patient’s course of 
treatment was no longer imposed.
In fact, patients began negotiating
each phase of their treatment plan with their physician.
Dr. Basaglia’s goal was “de-institutionalization,” 
shifting from internment, which was the approach to
treating mental health disorders
taken by the asylum to a focus on the patients’ quality of life
- both inside and outside the facility – 
with their reintegration into society
as the ultimate goal. 
Efforts were made to provide patients
with homes that included solid social networks,
and ensured them a standard of living as high as possible,
even after they were discharged from the asylum.
Dr. Basaglia’s approach was
summed up in an interview 
when he was asked:
"Are you more interested in the
patients or in the disease?" 
His reply was, "To be frank in the patient’'.
Restoring an active role to the patient
became a priority, which explains
why social cooperatives were at the very core
of Basaglia’s system.
They were established to integrate patients
into the work world, and to provide
them with a sense of purpose.
Thanks to the cooperatives’ help,
patients were employed with meaningful work
and were remunerated for their services,
hence when they left the asylum,
they had the ability to enjoy a certain
amount of economic freedom,
and pursue their reintegration into society.
This project remains in existence today.
Indeed, the cooperatives’ staff is mainly
composed of patients or former patients
of the mental health department.
As for life inside the park,
Basaglia’s aim to make
the asylum as open as possible
restored the role of nurses, who,
once again, became actively involved in
assisting and caring for their patients.
A concrete symbol of the rebirth is Marco Cavallo,
a papier-mâché sculpture depicting a nonfictional horse
which had been used to carry clothes, and other items,
to and from the laundry.
Patients and nurses “adopted” the horse
when it was too old to work, 
and was about to be slaughtered.
The horse had, in fact, become
a symbol of freedom for the patients,
as they saw him regularly leave the park
where they were secluded. 
Marco Cavallo was created by patients
with the help of several artists,
including Vittorio Basaglia and Giuliano Scabia.
The model evokes the therapeutic role
that Basaglia assigned to art.
For example, theater companies frequently
gave performances in the park’s theater,
and patients were encouraged to participate
in creative activities in order to
set their imagination free.
The implementation of Basaglia’s project
entailed a complete overhaul of the asylum’s role,
locally and globally.
Thus, in 1978, the so called “Basaglia law”
came into full force,
and mental asylums were closed.
When the asylum closed in Trieste in 1979,
the park began to play an active role in city life,
implementing a network of integrated services.
It now hosts the regional health authority
and it’s various departments,
including treatment for drug addiction
and mental health services.
The latter is particularly important
because it is the only institution that provides
psychiatric assistance without
resorting to hospitalization.
But it wasn't just the San Giovanni Park
that opened itself up to the city; 
the city itself entered the park,
thus achieving the physical and mental integration
that Basaglia so desired.
In fact, the community,
along with crucial contributions from social cooperatives,
has revived the San Giovanni Park. 
In addition to the regional healthcare authority’s headquarters,
the park houses a day care center,
various departments from the University of Trieste
and the Antarctic Museum.
There is also a bar and a restaurant,
created during Basaglia’s time
and which were used for employing patients and
providing them with social contact opportunities.
Thus, Trieste’s residents were able to return
to a part of the city that had been closed
and isolated for a prolonged period of time.
Today, the park hosts numerous events,
such as the Lunatico Festival,
concerts, an open-air cinema
and workshops for children and adults.
The Basaglian revolution, however, 
not only benefitted the city of Trieste;
it had worldwide impact.
Its effects have extended to many European cities,
and have spread abroad.
In 1973 Basaglia’s model 
became a pilot project for WHO, 
the World Health Organization.
In 1986, the same mental health department
collaborated with WHO with the aim of
promoting innovative treatment
in the mental health sector worldwide.
To conclude, in 2005 the Department of Mental Health
became the leading center for the
development of mental health services in Europe.
This is an acknowledgment of the institute’s
long-lasting commitment
to establish new community mental health
policies as they continue the work of
de-hospitalization and in the
implementation of local services.
Well, who would have thought that
a park could be the symbol of
such great change!
But it is often in the most
unexpected places that
revolutions take place.
