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18/19 November 2022 - Teatro Olimpico, ROME
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Designing Mental Healthcare Spaces in National Health-care System through the Redevelopment of the Urban Space based on the Human Birth Theory

  • Farina S.,
ABSTRACT

This research proposal has been developed from the graduation thesis “COMUNITA’ TERAPEUTICA PORTO FLUVIALE – the design of a psychiatric residential facility with  therapeutics-rehabilitation scope, of a day-care center and of private residences, via the recovery of the former Commissary Warehouse, via del Porto Fluviale 13, Ostiense district”.

 

The research here outlined aims to identify new ways of conceiving the spaces of the Psychiatric Healthcare Service and concurrently the urban space.

The Italian Mental-health Service is currently provided in a discontinuous and insufficient manner, not only from a clinical point of view – since, for several reasons, it merely offers assistance and does not lead to the recovery of the patient (Dell’Erba & Migliorini, 2017) – but also from a practical perspective: the number of facilities capable of receiving patients with more or less severe psychiatric pathologies is indeed far too few compared to the real demand (Ministry of Health, 2019) 1.

The conditions under which these services are provided are in most cases unsuitable: with the exception of private facilities 2, often the therapeutic activities take place in cold and unwelcoming hospital environments not suitable for respecting the accuracy of the therapeutic setting, which is fundamental to obtain tangible improvements in patients. Furthermore, even when located within the city, the facilities are often in peripheral areas, making it difficult to move around, and they are configured in such a way as to not encourage relations with the outside world. Those shortcomings inevitably have also repercussions on the work of psychiatrists, psychotherapists, and healthcare workers, whom are often unable to follow a patient beyond set schedules – almost always insufficient for a successful therapy – and in facilities unsuitable for the purpose (Dell’Erba & Migliorini, 2017).

The shortcomings in the Psychiatric Healthcare Service originate from the unsuccessful attempts of the legislation to legally regulate it from the beginning of the 20th century onwards, with ineffective results, disconnected from the needs of the people directly affected by the measures 3. Starting with the Giolitti Law of 1904, it was possible to see the enactment of a series of extremely repressive regulations. In 1978, with the Basaglia Law, a total reversal took place, as this was the first law repealing the Giolitti Law providing for the closure of asylums 4 (Dario M., Del Missier, G., Socco, E. & Testa, L. 2016). Asylums were nothing more than cramped and miserable places of confinement, however, as we are well aware, this do not meant that the mental patients should be left to their own devices, that they could not recover, and that there should be no place where they could be cured. Straitjackets, electroshock, and even four-meter high walls surely cannot and should not be the answer (Coccoli, 2015), neither for architects, nor  psychiatrists and any other human being dealing with this “mysterious monster” that is mental illness, often very difficult to comprehend. As well the answer cannot be absence, neglect, or abandonment either.

A radical change of the current situation can only come about through interventions based on Massimo Fagioli’s Human Birth Theory, which has revolutionized the thought, the research, and practice, in the psychiatric field and beyond (Fagioli, 2017). Franco Basaglia was by no means the first to think about knocking down the terrifying walls of the asylum. Already in 1960, in the Padua Psychiatric Hospital, directed by Fernando Barison, new experiments were beginning that sought to break away as much as possible from the asylum practices of the time (Dario, Del Missier, Socco & Testa, 2016); in particular, Massimo Fagioli, in those years as a very young psychiatrist, organised a unique and original ward life for his patients: he allowed the patients to move freely around the facility and follow the work of the nurses, concretising a breaking down of the walls of the wards, taking responsibility for bringing the patients on outings to Padua and Venice; most important of all, he committed himself to always, and continuously, talking to the patients, establishing a true human relationship with them. He believed that this in itself had therapeutic value, and above all he was always firmly convinced that mental illness exists and must be treated, in order to regain that physiological and original sanity that is characteristic of all human beings. Fundamental to this research is Fagioli’s thought that it is necessary to avert the risk of the ward becoming a micro-society closed in on itself, and instead give the mental ill patients the awareness that they are being treated to eventually be able to go outside, to reintegrate into society, into the world. Not only no walls or mechanical restraints, but preeminently the patient is not abandoned to himself or to the disease (Coccoli, 2015). Massimo Fagioli’s caring relationship with asylum patients aimed at recovery, therefore the relationship with the city, urban space, and society is seen in general as fundamental. This is why today – more than ever – it is necessary to imagine, design, and build facilities suitable for the care – and not only for the assistance – of the mentally ill patients, in order to let them able to interact and communicate with the urban context via the right points of contact. Not limited to this, we may even say that in order to imagine spaces that are different and new from those existing today, it is essential to develop transversal design methods that at the same time include and favour the redevelopment of the urban space 5.

Similarly to the spaces used for the treatment of mental illness, the urban space is often inadequate to the realization of human request and sometimes even their needs, being in a degraded and abandoned condition <6/sup>. Some neighborhoods lack of essential services, and sometimes urban contexts can be hostile, and difficult to live in, as they are not configured to meet human needs (Rosmini, 2016).

This research aims to investigate the possibilities and ways in which spaces for the treatment of mental deseases can be incorporated into the urban and social tissue. Designing new spaces based on Massimo Fagioli’s Birth Theory and his revolutionary therapeutic praxis could have twofold positive implications: favouring and facilitating the patient’s recovery and reintegration on one hand and revitalizing and regenerating the urban context on the other.

 

Note

  1.  This was firstly verified by reading the “Mental Health Report – The year 2019” drawn up by the Ministry of Health (included in the bibliography), which contains data regarding both the occurrence of mental pathologies and the available facilities. On the other hand, about the suitability of said facilities, first-hand inspections were carried out, and comparisons were sought with professionals in the field (psychiatrists, psychologists, health workers) who have direct experience in the field.
  2. It should be noted that this is not intended to imply that these services are provided appropriately and efficiently in private facilities, but simply that, given their greater economic availability, for example, the spaces have the potential to guarantee the minimum amount of privacy required when conducting a psychotherapy session, something that is often impossible to guarantee in the public sector if only for practical reasons such as the lack of suitable spaces.
  3. It should be noted that only the extremes of the chronology of historical development have been mentioned here, purely for the sake of synthesis. Interim measures will be developed more extensively and comprehensively as the paper is written.
  4. The Basaglia Law condemns the inhuman practices that characterized asylums, strictly forbidding new admissions, except for the TSO. Basaglia’s thinking behind this measure is, to say the least, deadly: mental illness would only be a different way of being in the world, just like health care; consequently, giving freedom to the ‘sick’ would be the only way to alleviate their suffering, unmasking the bad intentions of the Public Institution, from which, according to Basaglia, psychiatry should be separated, as it is instrumentalized by it to imprison the sick.
  5.  It is understood that several concrete design proposals have been developed, and constitute, together with the theoretical research work, the content of the dissertation to which the research paper refers. For the time being, for reasons of space, we have privileged an exposition of the most significant contents, postponing in-depth studies that require more space and elaboration when writing the paper.
  6.  It is not unusual, for instance in Rome, to come across completely abandoned spaces, left to their own devices, such as industrial-era artifacts, urban voids, and waste sites.

Bibliography

Books

  • Fagioli, M. (2017). Istinto di morte e conoscenza. Roma: L’Asino d’oro edizioni.
  • Fagioli, M. (2011). La marionetta e il burattino. Roma: L’Asino d’oro edizioni.
  • Fagioli, M. (2011). Teoria della nascita e castrazione umana. Roma: L’Asino d’oro edizioni.
  • Fagioli, M. (2011). Bambino donna e trasformazione dell’uomo. Roma: L’Asino d’oro edizioni.
  • Fagioli, M. (2005). L’uomo nel cortile. Roma: L’Asino d’oro edizioni.
  • Fagioli, M. (2017). Conoscenza dell’istinto di morte. Roma: L’Asino d’oro edizioni.
  • Dario M., Del Missier, G., Socco, E. & Testa, L. (2016). Psichiatria e psicoterapia in Italia dall’ Unità ad oggi. Roma: L’Asino d’oro edizioni.
  • Colamedici, D., Masini, A. & Roccioletti, G. (2011). La medicina della mente. Roma: L’Asino d’oro edizioni.
  • Biliardi, G., Solaroli, S., & Testa, L. (2016). Psicoterapia, cura e guarigione della malattia mentale. Roma: L’Asino d’oro edizioni.
  • Università degli studi di Firenze – Cattedra di igiene mentale, Fondazione Giovanni Michelucci, USL 10 E. (1994). Abitare la follia: percorsi riabilitativi in psichiatria: atti del Convegno nazionale e delle conferenze. Firenze: Regione Toscana.
  • Amendolagine, F. (1996). Mulino Pantanella: il recupero di una archeologia industriale romana. Venezia: Marsilio.
  • Polci, S. (Ed.). (1989). Archeologia industriale a Roma: recupero urbanistico e sviluppo imprenditoriale delle aree dismesse. Milano: SugarCo.
  • Alessandrini, D. & Veltroni, W. (2005). Roma: il futuro è in cantiere dall’archeologia industriale alla nuova architettura cronache e immagini della città eterna. Roma: Edilazio.
  • Bonaventura, M. G., Caneva, G, Racheli, A. M., & Travaglini, C. M. (2011). Archeologia industriale: atlante dei siti nella provincia di Roma selezione di schede dal censimento. Roma: De Luca Editori d’Arte.
  • Marroni, U. (2018). La rigenerazione dei quartieri industriali: il progetto urbano Ostiense – Marconi. Roma: Ponte Sisto editore.

Magazines and periodicals 

  • Masillo, A. & Patanè, M. (2018). “Tanti raccontarono i sogni e io risposi sempre”. Left, 6.
  • Dell’Erba, A. & Migliorini V. (2017). Se curare la malattia mentale diventa un percorso ad ostacoli. Left, 48.
  • Coccoli, D. (2015). Intervista a Massimo Fagioli: “il problema è la cura, non le mura”. Left, 9.
  • Coccoli, D. (1992). Psichiatria e architettura, un “connubio” originale. La gazzetta di Brescia, 179.

Unpublished

  • Rosmini, E. (2016). Ri(abilitare) una fabbrica, strategie di riconversione del patrimonio industriale per nuovi modelli di tipo partecipativo. Unpublished doctoral dissertation, Università La Sapienza, Roma, Italia.
  • Arnone, D. Bianchi, N. & Dorigatti, G. (2013). Riqualificazione ex direzione magazzini commissariato Porto Fluviale, Roma. Unpublished master’s thesis, Università La Sapienza, Roma, Italia.
  • Iacovoni, A. (2012). Progetto di recupero dell’area dismessa di stoccaggio coke zona Gazometro – Ostiense. Unpublished master’s thesis, Università La Sapienza, Roma, Italia.
  • Lucchetti, C. & Pierini, E. (2017). Progetto sperimentale di recupero dell’ex magazzino dell’aeronautica militare in via del Porto Fluviale. Unpublished master’s thesis, Università Roma Tre, Roma, Italia.

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