The Blue Horse: A Symbol of Freedom in Psychiatry

At a time when psychiatric hospitals resembled asylums where patients disappeared behind walls for long periods that could extend to the end of their lives, psychiatrists were entrusted with protecting society from “these patients, their violence, and their eccentricities.” It was then that the story arose of the blue horse, Marco Cavallo. He was neither muscular nor a champion racehorse, but he became a hero and a symbol of breaking down the walls of psychiatric asylums, bringing psychiatric patients out, and returning them to their natural place in society. It is worth noting that even today, some families come to my clinic asking to admit their son or daughter to a psychiatric hospital forever. This idea is not confined to an earlier era; it continues into the present despite cultural and intellectual progress regarding mental health.

There was a horse that pulled the laundry cart at the psychiatric hospital in the Italian city of Trieste. When he grew old and became slow and weak, a decision was made to kill him. The patients staying at the hospital, however, wrote a letter objecting to the decision and asking that the horse be given a dignified retirement. City officials agreed and sold the horse to a pharmacist, who allowed him to spend his final years on his farm until he died.

Some time after bidding the horse farewell, those patients decided during an art workshop to make a model in his honor. They built a giant cardboard statue and named it Marco Cavallo. The model was enormous and could not pass through the hospital gate. This created a dilemma: how could they get it out of the institution? Some suggested keeping the model confined inside the hospital, while others proposed dismantling it and reassembling it outside the walls. On February 25, 1973, however, Franco Basaglia—the psychiatrist who pioneered the community-based approach to psychiatry and was the hospital’s director at the time—decided to demolish a hospital wall so that the model could emerge intact and unaltered. Marco Cavallo was accompanied by hundreds of patients who wanted to return to society, and they toured the city’s streets. One patient wrote on the hospital wall that Marco wanted to enjoy running. Marco has not stopped traveling since then, and he was sent throughout Italy as a testament to and symbol of freedom in psychiatry.

On May 13, 1978, Law No. 180, known as the “Basaglia Law,” was approved. The law represented a major shift in approaches to mental health treatment and the rights of people with mental illnesses. Before this law, mental health care in Italy, as in other countries, was centered primarily on psychiatric hospitals and isolated mental asylums. These institutions often had appalling conditions in which patients experienced inhumane treatment, including physical restraints and forced isolation. The Basaglia Law aimed to promote a more humane, community-based approach to mental health care, encourage the closure of psychiatric hospitals, and integrate people with mental illnesses into everyday life. The law also focused on patients’ rights and sought to eliminate discrimination and stigma associated with mental illness.

In 1979, one year before his death, Franco Basaglia said at a conference: “We are weak and belong to the minority, and we cannot win because power always wins. But at best, we can convince others of better values, and the moment they are convinced, we will win. In other words, we create a state of change that is difficult to reverse.”

The story of the blue horse, Marco Cavallo, demonstrates the power of human will and the capacity for change. It is a symbol of freedom and victory over restrictions and oppression in psychiatric practice. Although psychiatric patients endured difficult conditions and limited freedom of movement, they used their creative and literary abilities to save the horse, create positive change in their community, and affirm that even when others become unable to play an active role in society and offer little benefit, this does not mean that we should discard them. Instead, we must protect them and their rights until the last day of their lives.

Thanks to the courage of Franco Basaglia and his companions, a radical change was achieved in the treatment of mental illness in Italy and around the world. Their actions were extraordinary and succeeded in restoring dignity and freedom to people with mental illnesses. As we develop plans for mental health services at the level of ministries and official institutions, we should remember the story of Marco Cavallo and let it inspire us to take measures that protect psychiatric patients’ rights. We should not restrict services to hospitals, despite their necessity for some cases and for short periods.

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