The field of psychiatry and care for individuals with special needs has been profoundly shaped by radical experiments and practices that challenged oppressive norms. At the recent FreePsy conference on psychoanalysis and radical psychiatry, held at the Wellcome Collection in London, the spotlight was on transformative movements like the Saint-Alban experiment, Kingsley Hall, and the Cooperativa Sociale in Trieste. These initiatives questioned traditional views on mental illness, neurodiversity, and care, offering innovative and humane alternatives to institutionalization. Their lessons continue to resonate today, urging a reimagining of how we approach mental health care, with a focus on inclusion and human dignity. Reflecting on these movements, I am reminded of other pioneering approaches like Ferdinand Deligny’s work with autistic children and the Open Dialogue approach in Finland, which similarly challenged conventional thinking and offered new care models. These ideas remain vital for reshaping modern institutions and practices in psychiatry.
Here is an overview of those movements and ideas as well as some takeaways for modern mental health care institutions.
The Saint Alban Psychiatric Experiment
During World War II, Saint-Alban Psychiatric Hospital became a pioneering site for institutional psychotherapy under Dr. François Tosquelles, a psychiatrist influenced by Marxism and psychoanalytic thought. At a time when psychiatric institutions dehumanised patients and reinforced rigid hierarchies, Saint-Alban introduced groundbreaking practices to foster equality and growth.
Staff and patients rotated responsibilities, rejecting traditional power structures. Nurses and doctors abandoned uniforms to erase visible authority, and patients took on communal tasks, such as gardening and cooking. This approach sought to prevent institutional stagnation and foster collective participation.
Tosquelles and his colleagues explored how rigid family dynamics, especially within the nuclear family, could stifle individuality. They argued that such environments often contributed to the development of what society labelled as madness. By creating a space for free expression, Saint-Alban allowed patients to explore their individuality and enter the process of healing.
Ferdinand Deligny and Mapping Neurodiversity
Ferdinand Deligny’s work with autistic children offered another radical departure from traditional approaches. In rural France, Deligny created an open, non-institutional space for children to live freely and explore their surroundings. He observed and documented the children’s movements, drawing intricate maps to understand their preferences and patterns. These maps highlighted the children’s autonomy and inner worlds, honouring their unique ways of being. Rather than imposing therapeutic goals, Deligny celebrated the individual differences in autistic children. His work resonated with ideas from Deleuze and Guattari, emphasising the importance of non-hierarchical and non-conforming approaches to care.
Kingsley Hall and the Anti-Psychiatry Movement
Kingsley Hall in London, established in the 1960s by R.D. Laing and David Cooper, became a central hub for the anti-psychiatry movement, which questioned the medicalisation of mental illness. Kingsley Hall provided a communal environment where individuals experiencing psychosis could explore their emotions without medication or coercion. Staff rejected traditional treatment methods, prioritising freedom of expression and mutual respect over control. Laing argued that oppressive family dynamics could contribute to mental distress. Kingsley Hall created a space for residents to express themselves without these constraints.
Though Kingsley Hall faced challenges and eventual closure, its philosophy continues to inspire more compassionate approaches to mental health care.
The Cooperativa Sociale in Trieste as A Model for Deinstitutionalisation
Franco Basaglia’s work in Trieste, Italy, spearheaded the deinstitutionalisation movement in the 1960s and 1970s. Basaglia’s reforms transformed mental health care, prioritising community integration over institutionalisation.
Basaglia led efforts to close psychiatric hospitals, culminating in Italy’s landmark Law 180 in 1978. This law mandated community-based care as an alternative to asylums. The Cooperativa Sociale encouraged patients to participate in work and social activities, promoting autonomy and dignity. Trieste’s model demonstrated that humane care could replace traditional institutions by integrating patients into everyday life.
The Open Dialogue Approach in Finland
Emerging in the 1980s in Western Lapland, Finland, the Open Dialogue approach represents a contemporary application of radical care principles. Open Dialogue involves patients, families, and social networks in care, emphasising open communication on diagnosis and hierarchy. Unlike traditional psychiatric models, Open Dialogue integrates patients into their communities and seeks to understand mental distress in context. This approach prioritises collaboration, reducing power dynamics, and fostering trust between patients and clinicians.
Open Dialogue has gained international recognition for its compassionate and effective treatment of psychosis and other mental health conditions.
Lessons for Modern Institutions
The common thread across these experiments is their rejection of coercion, celebration of individuality, and commitment to creating environments that empower rather than oppress. From Saint-Alban to Open Dialogue, these movements offer enduring lessons:
- Reducing hierarchies fosters mutual respect and collaboration, creating spaces where both staff and patients can thrive.
- Rather than striving for normalisation, care should honour the unique ways individuals navigate the world.
- Whether through creative activities, dialogue, or unstructured movement, individuals have the freedom to express themselves authentically.
- Institutions must challenge societal and familial norms that contribute to mental distress.
- Care should occur within communities, not in isolation, to foster connection and dignity.
A Vision for the Future
The radical psychiatry movement and innovative approaches like those of Deligny, Laing, Basaglia, and Open Dialogue challenge us to rethink care. By prioritising humanity, creativity, and individuality, modern institutions can continue the legacy of these pioneers, ensuring that care is not just treatment but also liberation.