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Afternoon sun slides through the first fresh leaves of spring, mottling shadows over a group gathered around a radio transmitter in the gardens of the psychiatric hospital J.T. Borda. Patients, health professionals, visitors and musicians sit on yellow plastic beer stools under the trees, the grim concrete buildings of the hospital squatting prison-like behind.
Two residents of the Borda introduce the day’s show, the schedule chalked on an old blackboard. Throughout the afternoon, people read poetry, dance, sing, drink mate and play music. Occasionally, distressed howls float across the gardens from the barred windows of the hospital.
A middle-aged Latino rock-star type, with long hair, a felt cap, and one gold earring, puts down his guitar mid-song, overcome with emotion. Two men on each side hug him, and everyone cheers.
Everyone in the circle has a turn on the microphone, introducing themselves to the Saturday afternoon listeners, tuning in from their homes in nearby neighbourhoods. Later, spontaneous dancing breaks out, and the crowd sings along to a classic tango song.
This is LT 22 Radio La Colifata, the world’s first radio station broadcast from inside a mental hospital.
Every Saturday afternoon for the past 17 years, the radio has provided a link between those interned in the hospital and the community outside.
“La Colifata isn’t just a radio. It’s the use of the medium to produce spaces of community mental health where ‘madness’ is de-stigmatised, and where through the use of the voice, people suffering from mental health problems can recover some sense in their existence,” says the project’s director, psychologist Alfredo Olivera.
In 1990, Olivera was a student volunteer with ‘Cooperanza,’ a group who ran artistic classes inside the Hospital Borda. Talking to a friend who worked in community radio, he saw an opportunity for people who had lost all reference with the world outside the hospital to reconnect with everyday life. “La Colifata thus began as a space of inclusion, within a community radio, for the voice of a group of people who were not just suffering from mental health problems, but were socially isolated as well,” says Olivera.
Olivera would record the patients’ discussion of a particular theme, and then transmit them on the radio. Listeners called in and responded to the discussion, and Olivera then played their questions and comments to the residents of the Borda. Then, in 1992, the radio began live transmission from inside the hospital for five hours every Saturday.
The Crazy Lady
‘La Colifata’ means ‘the crazy woman’ in the porteño dialect Lunfardo – “but said in an affectionate way, not in an aggressive way,” says Olivera. In the programme’s early days, a caller asked what name those in the hospital would give their radio. The patients came up with a list, which was then put to a vote by the listeners.
Though the transmitter currently only reaches an area of about 30 blocks, content from La Colifata is repackaged into ‘microprogrammes’ which are then broadcast from other stations around Argentina and Latin America.
The radio has thus become a tool for society at large, together with sufferers, to confront and deconstruct the myths surrounding the idea of ‘madness’ and mental illness. “We create myths around phenomena that are hard to understand,” Olivera explains. “Institutions like the Hospital Borda, that shut people away, exist because society tends to reduce the phenomenon to the question of the ‘danger’ and ‘criminality’ of those suffering mental health problems.”
La Colifata is a space where the ‘crazy = dangerous’ association can begin to be broken down. “Even though someone, in moments of crisis, can sometimes exhibit violence or insensitivity, and need treatment – this is not all the time,” says Laura Gobet, who has worked at the radio since she was a psychology student in the late 1990s.
Equally important is La Colifata’s role as a therapeutic space, offering something different from traditional institutional practice. Often professionals from the Borda are surprised by the improvement of their patients after they have participated in the radio, says Gobet. “‘She’s never done that before,’ they say, or, ‘I didn’t know he sang the Blues!’”
For 20% of the regular ‘Colifatos’, the radio is their only contact with mental health professionals. The radio often has a crucial role in maintaining stability for those who have been released from the hospital into the community. According to statistics gathered since 2002, less than 10% of released patients who continued to participate in the radio have been re-interned, compared with 60% of those whose involvement ceased once they left the hospital.
Maybe most importantly, La Colifata gives people suffering from mental illness something sorely lacking in the current system of mental health treatment – empowerment, autonomy, and a sense of belonging. “This is one place in the world where people receive them, value them, wait for them – for many who don’t have anyone else,” says Gobet.
La Colifata is not the only project within the Borda aiming to challenge the traditional order of the psychiatric institution and improve the lives of its patients.
Down a dank staircase, under the official, privatised kitchens of the hospital, a tiny bakery operates. Pan del Borda is a collectively-run panadería which employs up to fifteen residents of the Borda to bake facturas, biscuits, and bread, and deliver them to customers within the hospital and in the Faculty of Psychology of the UBA.
The project – under constant threat of expulsion by hospital authorities – provides patients with employable skills and a small income, and helps to develop social links and integration.
Projects like La Colifata and Pan Del Borda give a sense of purpose and identity to people who, in addition to suffering from mental illness, are frequently condemned to decades of imprisonment in a public health relic of the 18th century – the lunatic asylum.
They are responding to a much broader issue – the end of the legitimacy of the asylum as an acceptable model for mental health treatment.
Since the 1950s, health professionals have been questioning the ethics of enclosing mentally ill people in large institutions. Between 1950 and 1980 the US shut down most of its mental hospitals, in a process known as deinstitutionalisation.
In Latin America, change came later – but in 1990, an international conference in Venezuela resulted in the Caracas Declaration, which emphasised the human and civil rights of the mentally ill and promoted a restructuring of psychiatric services.
According to the Pan-American Health Organization (PAHO), this restructuring requires the replacement of the psychiatric hospital with a multifaceted network of community based services – day hospitals, community treatment and rehabilitation centres, halfway houses, and mental health units situated within general hospitals.
“You cannot simply shut down a hospital, even if its patients suffer under bad conditions, without simultaneously opening other solutions. In the United States in the 1970s, massive de-hospitalisation resulted in a wave of homeless people who had nowhere to go,” says Jorge Rodríguez Sánchez, Head of Mental Health, Substance Abuse, and Rehabilitationfor PAHO.
Argentina now has the opportunity to avoid repeating other countries’ mistakes. “We now know that people with mental illnesses, even severe illnesses like schizophrenia, can actively participate in society, can hold important roles, and can work. The best rehabilitation for mental illness is not found in asylums, but in everyday care in the community and within the family,” says Rodríguez.
For psychologist Gregorio Kazi, co-founder of Buenos Aires-based ‘Movimiento de Desmanicomialización y Transformación Institucional’ (Deinstitutionalisation and Institutional Transformation Movement), real change will only happen when the community and those affected are involved in the process.When reforms are imposed from outside by institutions like the PAHO, he says, the result tends to be a recycling, rather than a dismantling, of the old model.
The movement formed under the auspices of Madres de la Plaza de Mayo, in response to shocking revelations in 2003 that patients in the women’s psychiatric hospital Braulio A. Moyano had not just been used as testing subjects for pharmaceutical products, but had been coerced into prostitution. Hospital staff turned a blind eye as men entered the hospital and paid to have sexual relations with the patients.
Atrocities like these are not isolated cases, says Kazi. “We’re talking about spaces which every day violate the human rights of thousands of people.”
For Kazi, the persistence of psychiatric hospitals in Argentina implies the continuation of an ideology left over from the last dictatorship. He sees parallels between the logic of interning ‘dangerous’ mentally ill people in asylums, and the logic of ‘national reorganisation’ which lead to the murder of 30,000 political dissidents and their sympathisers by the state.
“An analogy exists between the clandestine extermination centres of the dictatorship and the neuro-psychiatric institution as a space of rehabilitation. They are both spaces of social kidnapping, and both seek to ‘normalise’ and ‘rationalise’ the human subject,” he says.
“The equation of mental illness with dangerousness doesn’t make sense. Isn’t the existence of genocidal dictators, who have enjoyed impunity in our country, ‘dangerous’? These people are the ‘normal’ ones? The ‘healthy’ ones?”
If then, it is internationally and locally acknowledged that the psychiatric hospital is a cruel anachronism, why are so many mentally ill Argentines still living out their lives behind the walls of hospitals like the Borda?
The answer – just like mental illness – is complex.
Despite the introduction by the City of Buenos Aires of a Mental Health Law in 2000, which provides for the progressive substitution of mental hospitals with a broad community network of services, in practice, the law is not being applied.
Adolfo Méndez, a psychiatrist and forensic expert, is head of one of the departments at the Hospital Borda, and institutional ‘protector’ of the Pan del Borda project. In the corridor outside his office, patients wander aimlessly past the stark, grimy walls. Others sit on the floor, rocking repetitively, or stare vacantly at a television. The atmosphere reeks of stagnation and hopelessness.
Méndez believes that powerful interest groups in Argentina are blocking the much-needed overhaul of this system. It suits pharmaceutical companies and traditional psychiatry to preserve treatment models based on medication and exclusion, and unions are most interested in preserving the jobs of those employed in psychiatric institutions.
“I’m not saying that psycho-pharmaceuticals aren’t useful – but they are useful in specific situations, not as a strategy,” he says.
“Of course, if I were a multinational pharmaceutical laboratory, who would I support? The psychiatrist who uses medication as a strategy, for people who are condemned to 20 years or more inside an institution, or one who proposes to use fewer drugs and move treatment into the community?”
Yet change is possible. In the province of San Luis, hospital director Dr. Jorge Pellegrini and his colleagues have worked since 1993 to transform the traditional asylum-model Psychiatric Hospital into a progressive Mental Health Hospital, with an emphasis on in-community and out-patient attention.
“In San Luis, we are finished with the social shame, the structure and the ideology of the asylum. People are only committed to the hospital in periods of crisis, and they can be accompanied by family or friends,” he says.
“Before 1993, people were institutionalised, on average, for seven and a half years. Now, the average is four days.”
For Pellegrini, the continuity of the asylum model nationally results from the failure of national and provincial governments to incorporate its transformation into social and health policy. “There has still not been a political decision to end with these institutions of systematic violence,” he says.
In the meantime, projects like La Colifata and Pan del Borda continue to bring a shaft of light into the lives of at least a few of those behind the walls.
Hugo Lopéz is an ex-patient of the Borda and has been stalwart of the radio for the past five years.Every Saturday he returns to the hospital, to contribute ‘a constructive critique of society’ to the radio and see his friends who are still interned. “I had the fortune to be able to leave – but I continue supporting the others, who are stuck in a kind of labyrinth they can’t escape from,” he says.
“I don’t know if it’s one of my delusions, but I think La Colifata isn’t a crazy radio, it’s an ordinary radio, where we can express what we’re feeling, paint our reality, and maybe contribute a little grain of sand to making the world better. It’s a way of feeling alive. Everyone needs a reason to live – and I have a reason to live that’s called La Colifata.”