The sanatorium’s open-regime policy

The sanatorium’s open-regime policy reorganizes life inside the hospital around relative freedom of movement, recreation, work, and, for some patients, excursions beyond its grounds. Its defining feature is not unrestricted liberty but a general permission qualified by diagnosis, legal status, and placement in specialized units. The contrast between the activities available to many residents and the strict confinement of others makes the regime both a practical arrangement and a visible measure of institutional control.

Definition and Everyday Freedoms

Montserrat explains that the hospital had operated under an open regime for only a few years. Patients could move with relative freedom through the building and park. Some gathered in the bar to play dominoes, brisca, or parchis; others walked in the garden, talked as they went, or wandered into the extensive wooded grounds. They could also attend occupational-therapy sessions or work in the hospital’s many workshops, described as small industries that produced goods for sale. Patients were paid for this work, with earnings varying according to their abilities and output.

For eligible patients, the policy extended beyond the hospital grounds. They could travel by bus to nearby towns, an option especially popular during local festivals. The outings might include dancing, fireworks, and bullfights involving young heifers. This list gives the regime a social and economic dimension: patients were not only permitted to move about but could take part in activities, earn wages, and enter nearby communities. Yet the account presents these possibilities as the general rule, not a guarantee for every person in the hospital.

Permission and Its Boundaries

The limits become clear in the same explanation. Alice, who was under observation while awaiting a diagnosis, could not leave the hospital grounds. Patients confined by judicial order were also barred from going out when the admission notice specified that restriction. The difference between a broad institutional permission and an individual’s actual freedom therefore depended on the terms attached to a patient’s case. In Alice’s situation, the open regime did not remove the consequence of her pending diagnosis: she could be inside a comparatively mobile hospital and still be unable to go beyond it.

Movement was restricted more sharply for patients placed in special units, who could not move freely outside their assigned building. The units differed in severity. The most restrictive was the dementia ward known as the Lion Cage; less severe units held patients experiencing relapses or acute crises. One patient known as the Dreamer was to remain in a unit until his dream delusions disappeared. A woman whose disturbance in the dining room was associated with grandiose delusions had also just been transferred to a crisis unit. These examples show confinement operating not as one uniform rule but as a graduated response to patients’ conditions and episodes.

The Regime in the Hospital’s Spaces

The hospital’s physical arrangement gives that differentiation a daily form. Its large pavilion was divided by a corridor into two unequal blocks: one-fifth contained individual rooms, while the remaining four-fifths formed the women’s collective dormitory. That dormitory was itself only for the calmer patients; the account notes that it was not the hospital’s only sleeping area. Thus, even within a hospital described as open, patients did not share a single space or a single level of freedom. Their accommodation and access to the grounds reflected distinctions between groups inside the institution.

At the other extreme, the description of the Lion Cage makes plain how dependent some patients were on direct care. Without staff to dress them, they might wander naked through rooms or inner courtyards; without someone bringing food to their mouths, they might not eat; without being put to bed, they might not lie down. Toileting required staff to seat and clean them and to establish a conditioned routine. Without that assistance, some patients soiled themselves, smeared themselves with their waste, or ate it. The open regime therefore coexisted with intensive supervision and custodial care. Its general freedom of movement did not describe the circumstances of the most impaired residents.

Administration, Care, and the Meaning of Openness

For Alice, the regime’s openness did not mean she could disregard hospital rules. Montserrat advises her to follow regulations strictly and avoid distinguishing herself from the other patients, while suggesting that she might sometimes bend a rule on Alice’s behalf, as she had with the sherry. The exchange presents access to small exceptions as something mediated by personal assistance, not as an automatic entitlement. Alice’s status as a resident under observation also shaped which freedoms applied to her, despite the hospital’s wider policy.

The account sets that controlled mobility beside the administrative power to search, classify, and confine. On admission, Alice’s clothing, toiletries, purse, and hand luggage were inventoried, and everything was sealed. Later, when the hospital’s internal physician Rosellini believed her detention unjust, he risked organizing her escape. Their initial plan involved pretending that she was being treated directly by the head of her unit while a lawyer pursued legal steps to locate her husband. These circumstances do not negate the activities made possible by the open regime; they reveal its limits. The hospital could offer workshops, paid work, recreation, and excursions to some patients while retaining the power to restrict others’ movements and belongings.

Openness is consequently best understood as conditional access within an institution, rather than the absence of institutional authority. For most residents, it could reshape ordinary days through movement, social activity, work, and contact with nearby towns. For patients awaiting diagnosis, subject to judicial restrictions, or assigned to special units, the same hospital imposed boundaries that could be decisive. The policy’s significance lies in this contrast: freedom is part of the hospital’s everyday order, but it is allocated unevenly and remains subject to clinical classification, legal instructions, and care needs.