‘The best liar among us’ – On Photography and Psychiatry

Alvise Sforza Tarabochia 
Interviewed by Gloria Boeri 

A constant appropriation of the other’s face, gestures, body and, ultimately, privacy and humanity takes place in the public realm. As author and photography theorist Ariella Aisha Azoulay remarks, in our era, ‘Everybody and everything is liable to become a photograph’. It is from Venice, where I have been researching for two months, that I began thinking about this conversation with Dr. Alvise Sforza Tarabochia  Senior Lecturer in Italian and Head of School of Cultures and Languages at the University of Kent.

More than a city, this spring Venice feels like a stage set for a spectacle in which everyone plays the part of both actor and spectator. I find myself pondering on the power—and potential violence—of the photographic gaze as my own body and face enter, more or less knowingly, countless frames a day whenever I cross the city to make my way to the archives. Here, one only becomes hyperaware of a phenomenon that takes place all the time in the public space, a phenomenon so pervasive that one has no choice but to come to terms with it. Entering strangers’ cameras, personal memories and public social media profiles through the medium of photography is inevitably part of our daily lives. Yet, what is kept in the process? What is stolen? 

At stake here are not only issues of legal copyright and privacy but also of ethics and moral responsibility, issues that become all the more urgent and complex when the one being reduced into a picture is a vulnerable subject. What happens when the power relation between photographer and photographed is unequal? How do we deal with portrayals of pain, trauma and violence? 

This is the case of the photographs that Dr. Sforza Tarabochia examines in his ground-breaking interdisciplinary research, located at the intersection of psychiatry and visual culture. Much of his work focuses on that moment in the late Sixties, in Italy, when photography turned from being a tool of oppression and categorization of the mentally ill patient (identikit shots that served taxonomic purposes) into one of the chief weapons of radical psychiatry.  Spearheaded by the Venetian psychiatrist Franco Basaglia, the movement’s struggle led to the adoption of Law 180 (or ‘legge Basaglia’), the reform of psychiatric healthcare and the subsequent closure of mental asylums. As Sforza Tarabochia underlines in his ‘Photography, Psichiatry, Impegno: Morire di Classe’ the passing of this Act 44 years ago, on May 13th, 1978, was ‘the culmination of a long and winding path that besides clinical and social experimentations involved a coherent political strategy of communication.’ Photobooks represented a crucial element of that strategy. 

Starting from 1965, photographers such as Carla Cerati, Gianni Berengo Gardin, and Luciano D’Alessandro entered the secluded space of the asylum to tell the patients’ stories. Their pictures revealed for the first time to the public the dire conditions in which patients lived and their painful isolation, resulting from their pathologies but also from the alienation imposed by the institution itself. These photographs were meant to reassert the humanity of the mentally ill in a society that had managed to other and hide them for the sake of social order.

Cover of Morire di classe
Psychiatric hospital, Parma. From Morire di classe. Photo: Carla Cerati.
From Morire di classe.

Q

As an art historian I am fascinated in the unique way in which you grapple with images. Let me begin by asking you if there was any specific experience or picture that first triggered your interest in the visual? What do you think are the biggest challenges—as well as rewards—of approaching themes surrounding mental illness through this lens?

A

I grew up surrounded by the visual. My dad was a passionate amateur photographer and obsessed with creating photographic memories of me growing up – he did so with legendary cameras such as the double stroke Leica M3 and the Olympus XA I would later learn – and I hated it. Today I am grateful he did, but I still cannot look back at those pictures. There is a specter frozen in them of a reality that was always already lost, the capturing of moments having been driven by the anguishing awareness that they will too soon become only memories. My mum was an academic herself, professor of history of medieval art – with a specialism in manuscript illumination. Obviously, I expressed no interest whatsoever in her work until I grew up but her line of research always foregrounded the cultural and social revelations that images can elicit. I guess therefore that I grew up immersed in the visual, aware of the unsettling power of photography and of the profound socio-cultural meaning of images.

Approaching any topic that relates to medicine from the point of view of the humanities (or social sciences for that matter) requires the researcher to remain very humble. 

Approaching any topic that relates to medicine from the point of view of the humanities (or social sciences for that matter) requires the researcher to remain very humble. We are dealing with human suffering and we are entering into a field that is already populated by well-established experts. The role of the humanities is to reveal human suffering where it is concealed or overshadowed – but this can very easily become a showcase of human suffering that justifies the deployment of the humanities against the medical sciences.

Most importantly though I think the role of the humanities is to critically understand the ways in which we ascribe meaning to the real and/or we forge it outright.

Most importantly though I think the role of the humanities is to critically understand the ways in which we ascribe meaning to the real and/or we forge it outright. This is also very risky. In criticizing institutional psychiatry for instance or highlighting the continuity between phrenology and the use of fMRIs in psychiatry we must be careful not to deny the ultimate biological nature of life itself (thus also of the psyche), the daily struggle of patients suffering because of mental disorders, the way in which countless psychiatrists improve the quality of life of those who suffer or the pivotal contribution that imaging techniques give to neurology to mention just a few. Ideas appropriated from the humanities and decontextualized from the scholarship that makes them rigorous scientific findings, end up all too easily at the shaky foundations of conspiracy theories and vague denialisms – we cannot allow this.

Ideas appropriated from the humanities and decontextualized from the scholarship that makes them rigorous scientific findings, end up all too easily at the shaky foundations of conspiracy theories and vague denialisms – we cannot allow this.

Q

You have spoken with Dr. Arnaldi about the fascinating ways in which mental disorder has been visualized in the past through paintings and prints. Yet, there is a fundamental difference between those media and photography: its presence before the scene photographed, or indexicality. In order to portray mental illness, the photographers whose work you study had no choice but to cross the border of the asylum and engage in a physical encounter with the patients. As Azoulay remarks, this entails ‘a civic space’ in which ‘photographers, photographed subjects, and spectators share a recognition that what they are witnessing is insufferable.’ 

Let’s begin with the first party of this contract: photographers. Could you tell us more about their aims and visual strategies? How do you think their direct encounter with mental suffering shaped their work?

A

You preface your question with a crucial point: indexicality. Indexicality and symbolism chase each other in all images and we are persuaded – not without good reasons – that photographs lean on the side of the indexical whereas other images – such as drawings and paintings, are more open to symbolism. 

As Eugene Smith quite rightly put it however, ‘photography is the best liar among us’. Since we believe in its natural indexicality we tend to overlook the symbolism with which it can be imbued. 

As Eugene Smith quite rightly put it however, ‘photography is the best liar among us’. Since we believe in its natural indexicality we tend to overlook the symbolism with which it can be imbued. And, despite the undeniably more subjective nature of other forms of visual representation, nothing stopped scholars from giving representational/indexical interpretations of recurrent motifs in non-photographic visual representation (e.g. the insipiens always carries a staff because he has to fend off animals and mocking children – not as a symbol of madness). Azulay’s remark on the civic space in which photographers enter is a crucial watershed. The intention of ‘unmasking’ – as Basaglia and Ongaro put it in the preface to Morire di classe – of showing, ‘denouncing’ an otherwise concealed reality, the civic mission of photojournalists that is, adds an ethical dimension to their photographs – a dimension that would not be equally powerful were it not for the indexical ‘nature’ of photography.                 

The photographers themselves would be better suited to answer questions about their aims and visual strategies. There is however something that emanates from the pictures themselves and from their assemblage in pages and sequences that we can highlight and that we can piece together with interviews to the photographers themselves.

Luciano D’Alessandro, in Gli esclusi, says he entered the asylum with the intention of seeing mental disorder, but what he saw was solitude and abandonment. He expected these to be caused by the disorder itself but soon discovered that they are caused by institutionalization. His images are very intimistic

To this extent, for instance, Luciano D’Alessandro, in Gli esclusi, says he entered the asylum with the intention of seeing mental disorder, but what he saw was solitude and abandonment. He expected these to be caused by the disorder itself but soon discovered that they are caused by institutionalization. His images are very intimistic, they are close-ups and portraits – he is getting close to the subjects to allow spectators to meet their gazes and establish a relationship – almost to bridge their solitude.

Carla Cerati and Gianni Berengo Gardin enter the asylums to take the pictures that will be published in Morire di classe with the task of creating an anti-institutional photo book. Their intention was to be political. They take pictures that are slightly more distant from the subjects than D’Alessandro: the pictures show decaying structures, fences, grates, etc. There is an intentional revealing of the failures of the institution that is not present in D’Alessandro’s pictures.

Carla Cerati and Gianni Berengo Gardin enter the asylums to take the pictures that will be published in Morire di classe with the task of creating an anti-institutional photo book. Their intention was to be political. They take pictures that are slightly more distant from the subjects than D’Alessandro

D’Alessandro, in the preface to Gli esclusi, tells us himself that the encounter with mental disorder made him understand the devastating effects that the institution has on the patients. Cerati says she was shocked and that she fell into a state of pity – in an interview to Francesca Orsi she uses the Italian word pietà, which combines pity with mercy – a moral sadness she continues, the awareness of committing a violence against the inpatients (photographing them) for a just cause and for their own good.

Q

‘When people look at my pictures, I want them to feel the way they do when they want to read a line of a poem twice’, stated the American photographer Robert Frank reflecting on the stillness of the image and the attention it demands from its viewers. Temporality is a central theme in your study of photographs. In particular, you posit the format of the photobook as fundamental in promoting an active mode of spectatorship that set off action, more than contemplation. Can you give us some examples of photobooks and explain the narrative devices that prompt such viewing? 

A

I made of temporality a pivotal tool of my analysis in reference to Morire di classe because of the nature of that photobook. The sequences of pictures and the assemblages with the quotes allow readers/spectators to create narrative structures, piece together the photographic and textual atoms into a story. I don’t believe temporality to be necessarily a universal tool of analysis of any photobook, my approach was very specific to the protocinematic structure of Morire di classeGli esclusi, for instance, has no temporal layers and there is no structured narrative there. Don’t get me wrong: I am not saying that the message is weaker, just that the anti-institutional momentum of the photobook is channeled through means other than narrative and temporality: the static nature of expressions, the repetition of gestures and postures, the multitude of inpatients, the insistence on hands, etc. all of these contribute to creating a strong a message via visual impact. Gli esclusi could be considered more immediately impactful than Morire di classe, which also features strong, shocking images, but needs more interpretative work to decode the interplay between snippets of text and images.

Q

The gazes of the patients are the ones that are most often removed from the discussion on these photographs. What do you think it meant for these vulnerable patients to be subjected for the first time to the lens of photographers who suddenly landed from outside of the walls they were relegated in? Do testimonies of photographers or of the mentally ill exist and how do you strive to take into account their agency in your work?

A

Berengo Gardin remembers that in Gorizia he and Cerati were involved in the assemblee that took place in the asylum with psychiatrists, nurses and inpatients (a ‘politicised’ version of the therapeutic community). He recalls that 95% of inpatients were happy to be photographed. However, they also entered into closed asylums – in Parma they were asked to hand in the film rolls, and Berengo Gardin gave them new ones, hiding the undeveloped ones in an umbrella, in Ferrara they sneaked in thanks to a psychoanalyst who let them in when surveillance was at its minimum. So while some patients were aware of the photographers and allowed them to have their pictures taken, many did not. Cerati remembers being bitten by one of the patients, she did not ask him for permission to take the picture and he just bit her. Cerati then said that he was right: she committed a violence and he reacted. The picture was then published in Morire di classe paired with a quote from a handbook of institutional psychiatry, which explains how to deal with insect, animal and inpatients’s bites.

So while some patients were aware of the photographers and allowed them to have their pictures taken, many did not. Cerati remembers being bitten by one of the patients, she did not ask him for permission to take the picture and he just bit her. Cerati then said that he was right: she committed a violence and he reacted. 

It’s a very strong statement that reveals the agency of the photographer and of the subject/inpatient, while at the same time revealing the institutional response (the ‘technical response’ Basaglia would have said) that would have been levelled to cancel the inpatient’s agency – the inpatient’s bite is just like that of an insect, there is no recognition that the bite might have been a significant expression (in this case of distress). Of course, the assemblage of this particular photo with this particular quote could be very obscure in Morire di classe without some contextual background.

Q

How did the photographic depiction of mental illness change after the Basaglia Law of 1978, as the patients moved from the closed institution to social integration?

A

There is little continuity between the initial use of photography in psychiatry (mugshots, diagnostic albums, admission registers, comparative albums, etc) and the photo reportages of the 1960s. The former were pictures of the disorder, in which the individual was important only insofar as photos allowed them to be pinned to their visual appearance to be easier to identify in case of escape or relapse. The latter were pictures of the effects of institutionalization on inpatients. There is no in between. During the process that led to the reform of 1978 the subject becomes the effects of de-institutionalization: we have many pictures by Gasparo and Butturini to name but two that depict the initiatives that were deployed to integrate asylum and outside world – the concerts in the San Giovanni in Trieste, Marco Cavallo’s creation and march, the Alitalia flight, Villa Fulcis, etc. After 1978 we see three trends emerge: 1) photos that foreground social integration – so photos that continue on the line of the effects of de-institutionalisation (Coletti’s 180 Basagliafor instance), 2) photos that foreground what remains of institutional psychiatry (see for instance the very recent work by Valerio Bispuri (on REMS and people suffering from mental disorders serving a sentence in Italian prisons), 3) ‘Abandonware’ photography of the abandoned spaces of the asylums (for instance Poma’s photos, to mention but one of the many). 

Q

Do you think there is a continuity in the depiction of mental disorders pre- and post- 1978 reform?

A

John Foot sees a continuity between photos of the disorder and photos of the effects of institutionalization (and we might hypothesize an extension of this continuity to photos of the effects of de-institutionalisation), after all these are all images that exploit the portraiture of the individual to give a message other than the identity and subjectivity of the portrayed themselves. There is certainly scope for this kind of consideration, but, going back to the quote by Azoulay to which you referred earlier, it is the civic space of a shared recognition that makes of pre- and post- reform pictures something completely different to the photos taken during the golden age of institutional psychiatry. And then there are the outliers: to name but two we have the wonderful portraits at Il posto delle fragole bar in the Trieste (ex-) asylum by Uliano Lucas (1987) and Giacomo Doni’s ongoing work of visual and textual digitalization of asylum memories. Uliano Lucas’s photos capture the individuality of those suffering from a mental disorder (and passers-by including psychiatrists and nurses) to invert the relationship between photography and psychiatry: instead of recording the difference between ‘normal’ and ‘abnormal’, photography is called upon to witness that, visually, ‘normal’ and ‘abnormal’ are indistinguishable. Doni’s work is layered in a rich and complex way: Doni gives life to memories forgotten in dusty archives, while at the same time enriching them with visual testimonies of the archives and places themselves and valorizing otherwise forgotten masterpieces of art brut. It saddles history, microhistory, visual culture and outsider art with rare grace and humbleness.

Instead of recording the difference between ‘normal’ and ‘abnormal’, photography is called upon to witness that, visually, ‘normal’ and ‘abnormal’ are indistinguishable.

Q

Do you think that the visual depiction of mental suffering remains of topical importance today in this image-flooded at the time of pandemics? Is it still an effective tool for the struggle against social discrimination and stigma? Has it turned into a therapeutic means for this mode of suffering that tends to elude language?

A

Photography has been accused of flooding the world with images since its very inception – fixating exposed images with mercury fumes was considered cheating compared to painting! Flooding the world with images means that photography has prompted us to become desensitized to the visual, to develop a less contemplative consumption of images, etc. The advent of the internet and digital photography has increased the proliferation of images a million-fold. This has been said time and again. So we could ask the question above for just about anything, and if we do we unravel a core question, that might reveal a deep seated contradiction: is visual depiction still of topical importance in an era of hyperproliferation of visual depiction? Has the visual self-annihilated with an excessive proliferation? It makes me think of my first experience with highlighting a textbook at school. I started using a highlighter and highlighted everything. It made sense to me, everything seemed important, though it defied the purpose of highlighting, of making something stand out. There is much that has been lost to the proliferation of the visual: the sense that visual literacy is a pivotal skill for instance, or the Benjaminian ‘aura’. But at the same time we have gained instantaneous communications, and an acquaintance with visual cues that would have been unthinkable just a couple of decades ago. The visual is and will always be of topical importance, but its production must keep abreast of its mode of consumption in order for it to capture the attention of an audience in the midst of an ever-increasing visual field.

Is visual depiction still of topical importance in an era of hyperproliferation of visual depiction? Has the visual self-annihilated with an excessive proliferation? It makes me think of my first experience with highlighting a textbook at school. I started using a highlighter and highlighted everything. It made sense to me, everything seemed important, though it defied the purpose of highlighting, of making something stand out. 

Going back to mental health and your question: yes, the visual is of topical importance. Perhaps, in a post-asylum era the single, shocking photograph might be one flick away from oblivion – whether it is because it does not speak to contemporary audiences, or because it is considered too gratuitously shocking. I am not saying it has to, just that it could be. Novel and multimedial approaches to the visual however, such as videogames, walking simulators, VR experiences, board games, interactive storytelling, illustrations, etc. have more purchase than ever and can greatly increase our awareness of mental health (and its history) and decrease the stigma towards mental disorders.

Q

Finally, I wonder, if you had to choose one single picture that you find of central importance to the understanding of mental pain, which one would it be and why?

A

If I had to choose a single picture only, I could not do it! I think it depends on the era and the kind of mental pain one is to understand. The photographic portraits of inpatients upon admission in the large asylums of old – sometimes just for their sheer amount – elicit a very strong awareness of the deprivation of individuality that so many people suffered because of their mental disorder. Some of these images reveal the panic of human beings who were not aware of what was happening to them. Many would die, sometimes decades later, there. These admission pictures reveal a powerful and inhuman force of coercion and control.

Many of the portraits in Gli esclusi and Morire di classe depict powerfully the solitude and abandonment of inpatients in the big institutions at the dawn of their closure. They show on the faces of the inpatients the urgency of destroying the asylum. One in particular in Morire di classe is paired with a quote by Rilke, that compares human beings to ‘peels’ that fate has spat – sono relitti, bucce di uomini, che la sorte ha sputato. I find that picture very powerful [see below].

But then we also have contemporary depictions of mental disorders that speak of the subjective experience of suffering, and these are also very strong and effective, even though they might be considered a little bit more playful and creative as it were than documentary photography. I am thinking for instance of Shawn Cross’s illutrationsChristian Sampson’s photos, or Toby Allen’s ‘Real Monsters’.

I think that being unable to point to a single picture that is of central importance to the understanding of mental pain speaks to the variability and individuality of mental disorder and to the power of the visual to adapt to this individuality to capture it best.

Books and essays

*Azoulay, Ariella, The Civil Contract of Photography. Zone Books, 2008.
*Carli, Maddalena.  Testimonianze oculari: L’immagine fotografica e l’abolizione dell’istituzione manicomiale in Italia. Memoria e ricerca 47: 99–113, 2014.
*Cesareo, Giovanni. ‘Follia ed informazione nella stampa italiana’ in Inventario di una psichiatria, ed. Carlo Pirovano, 29. Electa, 1981.
*Foot, John, ‘Photography and Radical Psychiatry in Italy in the 1960s: The Case of the Photobook Morire di classe (1969)’ in History of Psychiatry, 26.1 (2015), 19-35.
*Forgacs, David. Italy’s Margins: Social Exclusion and Nation Formation since 1861. Cambridge University Press, 2014.
*Foucault, Michel, The History of Madness. Routledge, 2009. 
*Goffman, Erving. Asylums: Essays on the Social Situation of Mental Patients and Other Inmates. Anchor Books, 1961.
*Schinaia, Cosimo, ‘Fotografia e Psichiatria’ in Storia d’Italia. Annali 20: L’immagine fotografica 1945-2000. Einaudi, 2004. 
*Sforza Tarabochia, Alvise, ‘Photography, Psychiatry, and Impegno: Morire di classe (1969) between Neorealism and Postmodernism’ in The Italianist, 36. 1 (2018): 48-69. 
*Sforza Tarabochia, Alvise, “Mental, Social, and Visual Alienation in D’Alessandro’s Photography”, The Years of Alienation in Italy, eds. Alessandra Diazzi. Palgrave Macmillan, 2019.
*Sforza Tarabochia, Alvise, ‘The Staff of Madness: the Visualization of Insanity and the Othering of the Insane’ in History of Psychiatry, 32.2 (2021): 176-94. 
*Sontag, Susan, Regarding the Pain of Others. Farrar, Straus and Giroux, 2003.

Photobooks and Catalogues

*Berengo Gardin, Gianni et al. Morire di classe. La condizione manicomiale fotografata. Einaudi, 1969.
*Butturini, Gian. Tu interni. Io libero. Bellomi Editore, 1977.
*Coletti, Dario et al. 180 Basaglia. Sinnos, 1996.
*Crepet, Paolo, Giannichedda, Maria Grazie et al. Inventario di una psichiatria. Electa, 1981.
*Depardon, Raymond. San Clemente. Centre National de la Photographie, 1984.
*D’Alessandro, Luciano and Piro, Sergio. Gli esclusi: fotoreportage da un’istituzione totale. Il Diaframma, 1969.
*Lucas, Uliano. La storia. Le storie. I centri di salute mentale in Puglia. Petruzzi, 1998.
*Lucas, Uliano. Altri sguardi: Immagini della follia tra memoria e progetto. T-Scrivo, 2001.
*Parmiggiani, Sandro et al. Il volto della follia. Un secolo di immagini del dolore. Skira, 2005.
*Scopelliti, Letterio. Manicomio Addio. Arti Grafiche Friulane, 1998.

Extras

Raymond Depardon | photographs of Italian Asylums 
https://www.magnumphotos.com/arts-culture/society-arts-culture/raymond-depardon-end-italys-asylums/

Giacomo Doni | project of visual and textual digitalization of asylum memories https://www.giacomodoni.com/

Uliano Lucas | Al Bar ‘Il posto delle fragole’, 55 portraits taken at the café of Trieste’s (ex)asylum
https://www.ulianolucas.it/reportage/al-bar-il-posto-delle-fragole-2/

Riccardo Poma | Vuoti a perdere, a photographic project on abandoned asylums  https://vuotiaperdereblog.com/2014/10/18/tu-prova-ad-avere-un-mondo-nel-cuore/

Dario Coletti | 180 Basaglia, video presentation of the photobook
https://www.dariocoletti.com/180_basaglia-r9600