In a society increasingly aware of mental health issues, the line between treatment and coercion remains disturbingly blurred — especially in Italy, where a decades-old reform has been both praised and criticized as outdated in the face of new challenges.
A recent exhibition in Milan, “Psychiatry and Human Rights: From Asylums to Psychopharmaceuticals,” revisits the long and often troubling history of mental health care — from the horrors of Nazi concentration camps and Soviet gulags, through the rise and fall of electroshock therapy and psychosurgery, to the landmark 1978 Basaglia Law, which closed psychiatric hospitals across the country.
The exhibit, organized by the Citizens’ Committee for Human Rights (CCHR Italy), not only documents this evolution but also raises urgent questions about contemporary practices — particularly the use of compulsory psychiatric treatment under Italy’s current legal framework.
“This exhibition aims to inform professionals — doctors, psychologists, social workers, lawyers — as well as the general public about a serious situation that exists in Italy, and indeed globally, regarding mental health,” said Alberto Brugnettini, Vice President of CCHR Italy , during an interview on TeleColor . “It’s a historical documentation of psychiatry from its origins to today, including all the mistakes of the past, up to modern times — including the so-called Basaglia Law.”
Named after psychiatrist Franco Basaglia, the law was intended to revolutionize mental health care by closing down asylums and promoting community-based treatment. But according to critics like Brugnettini, it never fully lived up to its ideals.
“In reality, the law wasn’t even written by Basaglia,” Brugnettini explained. “It was drafted by Bruno Orsini, a Christian Democrat psychiatrist and politician, and passed against Basaglia’s own objections. He opposed coercive treatments and feared that transferring authority from asylums to hospital wards would simply recreate the same oppressive logic inside new structures — a fear later confirmed by Italy’s Court of Cassation 50 years later.”
Indeed, the Italian Supreme Court recently ruled that the current system of Trattamento Sanitario Obbligatorio (TSO) — or mandatory psychiatric treatment — may violate constitutional rights. In an unprecedented move, the Court referred several articles of the law to the Constitutional Court, stating that they may be unconstitutional.
“The Constitution guarantees the right to health,” Brugnettini noted, “but the Court of Cassation has now affirmed that the right to freedom carries equal weight. It is unacceptable to deprive someone of their liberty without giving them the chance to express their reasons before a judge — perhaps with legal representation.”
International human rights bodies, including the United Nations , the World Health Organization , and the European Committee for the Prevention of Torture , have also raised concerns over Italy’s use of involuntary psychiatric interventions.
Guidelines jointly published by the UN High Commissioner for Human Rights and the WHO call for the replacement of what they describe as the “biological, mechanistic, and coercive” model of mental health care with one that is “humanistic, holistic, and respectful of human rights.”
Yet in many cases, the opposite appears to be happening.
According to Brugnettini, patients labeled as “voluntary” are sometimes coerced into signing consent forms under the threat of forced treatment — a practice the European Committee for the Prevention of Torture has condemned.
“They say, ‘Come in willingly or we’ll bring you in by force,’” he said. “So people sign, thinking they’re making a choice. But when they decide to leave, they’re restrained. That’s not voluntary. That’s coercion.”
The exhibition also highlights the continued use of controversial procedures such as electroconvulsive therapy (ECT) — commonly known as electroshock — despite growing international criticism.
“There are still four or five cities in Italy where ECT is used,” Brugnettini said. “While there is a ministerial circular — the Bindi Circular — that limits its use, we suspect that informed consent is not always truly informed. Patients may not be fully aware of the risks involved.”
He added: “Even psychiatrists struggle to explain why inducing seizures should be therapeutic. There’s no scientific consensus on how it works, yet it’s associated with memory loss, cardiovascular risks, and in some cases, even death.”
The exhibit features profiles of famous figures who suffered under psychiatric care — including Ernest Hemingway , who died by suicide after undergoing multiple electroshocks and wrote in his final letter that the treatment had “cured the illness but erased my memory,” and Marilyn Monroe , whose death was linked to barbiturate overdose.
Brugnettini argues that these stories illustrate a broader issue: the tendency to label complex human behaviors as medical disorders without biological evidence.
“In psychiatry, symptoms, signs, and diagnosis are often the same thing,” he said. “For example, if a child is diagnosed with ADHD, the symptoms are hyperactivity and inattention — and those are also the signs and the diagnosis. There’s no objective test, no blood work, no scan. These are labels applied to behavior, often based on subjective criteria.”
He pointed to the DSM-5 , the American Psychiatric Association’s diagnostic manual, which lists more than 368 mental disorders — each approved by vote rather than empirical research.
“We’re not anti-psychiatry,” Brugnettini clarified. “We’re pro-human rights. Our message is clear: reform the TSO law, restore justice, and align Italian mental health policy with international standards.”
As debates around mental health grow louder across Europe, Italy finds itself at a crossroads — caught between legacy and reform, between treatment and control.
And in that tension lies a fundamental question: When does care become coercion?
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First published in this link of The European Times.
