Serious abuse and coercive practices in Milano’s Hospital Niguarda Ca' Granda
The return of asylum ideology as an instrument of repression
by Erveda Sansi
What happens in the psychiatric wards of Milano’s Hospital Niguarda Ca' Granda and in other hospitals, incredibly contrasts with the excellent results that women and men of culture and science have otherwise produced and still produce. It seems a return to the days of the infamous Inquisition. The scandal that came to light in recent weeks, following the heavy mobbing and the suspension from her job suffered by Dr. Nicoletta Calchi, leading psychiatrist at the Mental Health Department of Milano’s Niguarda Hospital, decided by the Board of Discipline, shows in all its savagery as the scientific progress has in many areas not only arrested, but has made giant steps backward.
Giorgio Antonucci, through his decades of work with patients who had previously been diagnosed with the most dire psychiatric diagnoses, has shown that neither the existential problems can be solved by locking up people in hospital wards, nor binding them to the beds, stuffed with drugs in order to get some sort of brain lobotomy. Indeed, it is when a person tries to cope with the difficulties of life that he needs understanding, sensitivity, empathy, help or more often, to be left alone. To be respected in all cases. Giorgio Antonucci, who has directed during twenty-three years two madhouses’ wards, has demonstrated, through concrete actions, that only through dialogue and support you can solve human problems. In facts, what has happened within the Niguarda Hospital’s SPDC (Psychiatric Service for Diagnosis and Treatment), and that reflects the way many psychiatric wards work, it is simply inhumane and criminal. The list of national and international institutes that put compulsory treatment perpetrated against people, defined as psychiatric patients or mentally disabled, under the heading “torture”, is long and includes the 1948 Universal Declaration of Human Rights, the 1950 European Convention for the Protection of Human Rights and Fundamental Freedoms, the 1991 United Nations Principles for the Protection of Persons with Mental Illness in (Principles on Mental Illness), the 1966 International Covenant on Civil and Political Rights, the Law of ' WHO (World Health Organization) on Mental Health: ten basic principles of 1996, the 1998 Human Rights Act in the United Kingdom, the 2006 UN Convention on the Rights of Persons with Disabilities, the 2008-8-28 UN General Assembly, 63th session, Item 67 (a) report by Manfred Nowak, Special Rapporteur of the Human Rights Council against Torture and Other Cruel, Inhuman or Degrading Treatments and Punishments.
Only about 15, (the number changes following the head physician, the head nurse, etc.) of the 321 SPDC existing in Italy, have publicly stated that they make no use of restraints, and do not lock the doors. They are part of the SPDC Club Open No Restraint. They are, at the moment, the SPDC of Aversa, Caltagirone-Palagonia, Caltanissetta, Enna, Mantova, Matera, Merano, Novara, Perugia, Portsmouth, Treviso, Trieste, Rome C., Verona Sud, DSM (Department of Mental Health) Venice.
Even Franco Basaglia, Edelweiss Cotti, Peter Breggin, Marc Rufer, Thomas Szasz, as well as the ENUSP’s (European Network of Ex-Users and Survivors of Psychiatry) members, to recall just a few of a long list of names, have shown through their theoretical works and practical methods the groundlessness of the psychiatric use of seclusion, restraints, electroshock and psychiatric drugs injurious to health. Michel Foucault explains very effectively how the psychiatric system functions as a Panopticon, as a social controller, and fulfills the specific function to maintain the class division of society.
On November 23, 2010, in the press room of the Court of Milan, was held the press conference of Milan’s Purple Telephone (Telefono Viola), on the serious facts happened in the departments Grossoni I, II and III of the Niguarda Hospital. Which was the reason why the Dr Calchi has been so heavily mobbed? The answer lies in her concern for her patients’ health, which led her to have human relations with them: her refuse to go against medical ethics, to participate to practices of restraint, as well as her will to resize, or scale down the administration of psychiatric drugs.
A clear example of what is the meaning of restraint in psychiatry, and its consequences, is shown by the death of Francesco Mastrogiovanni. After being restraint to bed for 80 hours, he dies in a state of extreme neglect. His agony was recorded by a hidden camera, and this is the reason that made it possible to see the footage on Youtube, where you will also find the video aired by “Mi manda Rai 3”. More information is available at <<www.giustiziaperfranco.it>>. The ruling of the Supreme Court, annulling the previous order of the Court, that did not believe to suspend the Vallo della Lucanias’ SPDC doctors, does not recognize the “exceptional, occasional, contingent” character to the Mr. Mastrogiovanni’s prolonged physical restraint (restraint that caused the death), and also condemns the widespread violation of criminal laws, health standards, human dignity respect rules, and highlighting over all the responsibilities of the manager and the doctors, emphasizing that there was not an exceptional case, but a practice extended to other patients, therefore systematic. The judge of the Supreme Court was horrified analyzing what happened in Vallo della Lucanias’ SPDC.
One more death imputable to restraint is the one of the stallholder Giuseppe Casu. Guilty of having pursued his will to work as a peddler in the town square, he was fined, not only, but he was subjected to Coercive Psychiatric Treatment, even after having paid all his fines. He was tied up to the psychiatric ward’s bed, where he died after a week without anybody would untie him. The experts who investigated the case, consider “excessive” to bind a patient to bed, also in order to prevent him suicide or force him to heal, and come to this conclusion: “The direct coercion is not among the services requirable to the psychiatrist. And since the psychiatry’s new organization chart does not foresee custodial staff figures (as it did before the Basaglia law that closed asylums); having failed this requirement that characterized the old asylum legislation, the use of physic strength is outside of the therapeutic relationship”. Seven doctors at the Cagliari’s Santissima Trinità’s psychiatric ward, were charged with kidnapping and aggravated abuse of power (by Unione Sarda, 21 October 2010).
Let's go back to the most serious abuses of coercive practices in use in the three Grossoni departments of Milan’s Niguarda Hospital, exposed in the press release of the Milan’s Telefono Viola (here below summarized and fully available on www.ambulatoriopopolare.org, www.news-forumsalutementale.it and senzapsichiatria.blogspot.com).
Meanwhile, 112 patients have written an open letter denouncing the situation and in defence of Dr. Calchi, where they state that “more health professionals, a doctor and a nurse are actually mobbed, other health professionals were forced to leave the hospital because of the DSM (Mental Health Department) Director. This letter was undersigned by 500 signatures.
“What happens since long time in the Grossoni I, Grossoni II and Grossoni III wards, seriously obscures the public image, the professional reputation and even the honourableness of the Hospital Niguarda Ca’ Granda”, say the Telefono Viola’s volunteers.
The physical restraint of mental asylums inmates was one of the most common and inhuman practices: the straitjacket was for centuries the symbol of the suffering bestowed to persons deemed mind ill. Yet, since the second half of the 17th century to keep a person tied to a table (to a bed as well) was been considered by the European legal culture, an unacceptable act of physical violence, a real act of torture, like all other corporal punishments, ended up being banned by the continent’s criminal law. The rejection of physical pains in the punishment of crimes was one of the most significant signs of transition from feudal to modern times, yet this principle has never been able to cross the gates of many mental hospitals, which, again from the end of 1700 have spread across Europe. In our culture, the irrational fear of madness, the irrational fear against those who, were interned in mental hospitals as “mentally ill” (as well as a modern scapegoats) has allowed the torture of physical restraint (along with an extensive list of other horrors) remained in vogue at mental hospitals schools for nearly two centuries, until about the last decades of 1900. In fact, although the definitive end of the use of the straitjacket, the practice of physical restraint in psychiatric wards has remained, though not everywhere, even after the law 180. Too often physical restraint in psychiatric wards is of unspeakable violence, which produces injuries, wounds and irreversible damages.
The Niguarda Ca’ Granda Hospital’s DSM (Mental Health Department) advises Milan’s University Clinical Psychology Specialization students, as well as his mental health professionals, to contain unquiet patients with the infamous spallaccio (tied up by the shoulders) of asylums memory: “When the crisis shaking is uncontrollable, it may be necessary to force the patient supine; and this is achieved by a sheet, rolled up properly, which stops its back on the floor of the bed, tied behind the head of it. This must be regarded as an interim measure, pending the medication make the necessary sedation”.
In this way, the restraint becomes very painful, because of the high pressure that creates the sheet rolled up against the neck, shoulders and armpits of the person contained! In this way, the strong stretching and the strong muscles compression, in a short time rises up the risk of injury to the brachial plexus distal nerve, causing paralysis in the arms of the person fixed restrained to the bed .
It is clear to everyone that the spallaccio is a procedure that:
- Inflicts immediate pain to the bound person;
- Causes a stretching of the upper limbs and shoulders, armpit and neck;
- Forces the person so closely linked in a forced position which prevents all movements at all;
- Obliges the other inmates to attend the coercive treatment inflicted on one of them (which is not wrong to define atrocious).
“The "justification" that the spallaccio is a temporary measure”, Telefono Viola concludes, “is a blatant lie: everyone knows that an intravenous sedation gives his full effect after just 10-15 minutes. And we newer heard that a spallaccio (as well as any other form of restraint) that lasted less than several hours or days. Of course we know very well that the spallaccio is not rare at Grossoni, and that sometimes it lasts entire days, but, nevertheless, even we of the Telefono Viola have always thought that the DSM top managers formally deemed as illegal this kind of physical restraint proceed, while allowing its use in the wards. But no: the spallaccio is part of the Niguarda DSM protocol! It is also taught to the Milan’s University Clinical Psychology Specialization students! In other words: the madhouse is dead, long live to the madhouse!
In December 2008, Margherita De Bac on the daily newspaper Corriere della Sera, asks Lorenzo Toresini, SPDC Club open doors no restraint chairman, how comes that 30 years after the law 180, the vast majority of the 321 national SPDC still bind their hospitalized. Toresini's answer is:
“The base of these behaviours is ideological. The restraint is considered a medical act. This is unacceptable. Italian law does not specifically deny the straps to the mentally ill. But domestic violence is punished under the Criminal Code. Most traders prefer to bind the patients rather than to speak with them. The structural problems and a lack of staff are a pretext. It is a question of dignity. To tie is not professionally dignified”.
Physical restraint in psychiatry, as was the case in asylums, is a disguised form of punishment. The coercive psychiatric interventions are causing injury and suffering, terrorizing and causing damage to both psychological and physical, as reported in her presentation Tina Minkowitz to the Committee against Torture in 2006: "To see how every day I deteriorated intellectually, morally and emotionally, terrified me. First my interest for political issues disappeared, after my interest in scientific problems, and then my interest in regard to my wife and my children". The art. 3 of the European Convention of Human Rights declares that "No one shall be subjected to torture or to cruel, inhuman or degrading treatments or punishments". Tina Minkowitz, on behalf of Mind Freedom International, notes that the coercive psychiatric interventions should be classified under this head.
Milan’s Telefono Viola (Purple Telephone) complaint:
Mohamed M., because of the restriction at Grossoni I, undergoes a bilateral paralysis of the brachial plexus, which means that he has both arms paralyzed. Did Mohamed M. suffer the spallaccio? The treatment that in a contained person leads to a massive rhabdomyolysis, is the infamous spallaccio long time protracted. As soon as at Grossoni 1 they found that Mohamed had lost the use of his arms, they quickly transferred him to the medicine ward “Medicina 2”, and made all the ward’s documentation disappear.
Rita F. because of a long and senseless restraint suffered at Grossoni I, gets decubitus ulcers, pulmonary thromboembolism, deep vein thrombosis and an urinary tract infection.
Francesco D., admitted to MURG (Urgent medicine) for severe respiratory failure is transferred to Grossoni III and after just three days dies. Did Francesco D. die because contained? On 26 September 2008, Francesco D. goes to the Emergency Room for a psychological assessment; there isn’t any psychotic emergencies, he is hospitalized for dyspnea in Urgent medicine in order to be treated. Francesco D. is an obese person, and a chain smoker. The MURG doctor, highly irritated by the inability to make him stop smoking, calls the Dr. Calchi to transfer him to the Niguarda’s Grossoni II psychiatric ward. Dr. Calchi, knowing that in her ward a patient, in order to prevent him from smoking, would be tied up to the bed; and that for a patient in those conditions the restraint can be deadly, opposes firmly to this admission, and when asked by the MURG doctor, she writes dawn her opposition. A few hours later the attending psychiatrist that replaces Dr. Calchi accepts the request of the MURG, and Francesco D., with his severe respiratory failure is transferred to Grossoni II. After just three days, Francesco D. "was found in a condition of circulatory arrest and, vainly subjected to resuscitative cares, was pronounced dead."
By the blood tests and urine analysis done by the Niguarda Hospital Clinical Chemistry and Patology Laboratory, in 2010 October 21, it appears that Tullio C., just three days before his death was fine. Tullio C. was admitted to Grossoni III, whose head physician is Leo Nahon. All operators of the Grossoni wards and of the Department of Mental Health, knew that Tullio C. has been tied up to his bed at 11 clock in the morning and that 14 hours later, at 2 in the night, he was found dead in his restriction bed. That is: he felt ill, got worse, came in agony and died in an immense solitude, blocked by the wrists and ankles, crucified on his restriction bed. He had the great misfortune to die suddenly and prematurely in a particularly heinous and cruel way.
Marinella S. was a patient of Dr. Calchi. Dr Mariano Bassi, head physician of Grossoni II, in the perspective of "mobbing" Dr. Calchi, in the beginning of this year, assigns Marinella S. to a different doctor. With the new psychiatrist Marinella S. is tied to a restriction bed for 438 hours in a row.
Andrea S., until July was a Dr. Calchi’s patient. In July, after Dr. Calchi’s suspension, Dr. Mariano Bassi, head physician of Grossoni II 'turns' Andrea S. to a different psychiatrist of his team. Afterward Andrea S. was immobilized by 8 nurses, dragged by the neck along the Grossoni’s corridor in front of the other patients strongly impressed and frightened; he was than tied to the restriction bed, where he remained for 14 consecutive days! During this never-ending physical restraint to Andrea S. were carried as many as 9 daily injections of three drugs (three injections a day per each psychiatric drug)!
Milan, November 23, 2010