In these uncertain times, we’ve all been focusing a little bit more on the theme of mental health. When normal life gets suspended, and we are forced to adapt to circumstances beyond our control it inevitably takes a toll and affects a good many people. Mental health has always, to a degree, been a taboo subject, something to be brushed under the carpet and dealt with away from the light of day. In the 19th century, family members suffering in this way were almost considered an embarrassment and were often sent off to an institution which made little pretence at effecting a cure or some form of amelioration. Witness the expression ‘bedlam’, i.e. ‘it’s like bedlam in here’. The term comes from the St Mary Bethlehem Hospital in London, which from the Jacobean era onwards was simply known as Bedlam and became a synonym for madness and chaos. Even in the late Georgian/early Victorian era, the chief physician was accused of ‘wanting in humanity’ towards his patients.
It is against this background of maltreatment and ignorance that we turn to the Real Casa dei Matti, an institution founded in Palermo in 1824 by Baron Pietro Pisani. If the name lacks a certain delicacy (the Royal Home for the Insane), the same thing cannot be levelled at the enlightened attitudes of Baron Pisani. Unlike similar organisations in other parts of Europe and the United States, Pisani was focussed on the ‘moral treatment’ of his patients and foreswore the use of chains, segregation and beatings. Pisani’s archival entry in the Palermitan comune gives his birth as 1760, although they do admit that other authorities have stated he was born 3 years later. He had an aristocratic liking for the finer things, specifically painting and music, but he was no dilettante, putting his privilege to good use. Initially, he centred his efforts on the island’s cultural heritage, even intervening to prevent two rapacious English archaeologists from spiriting away, a la Elgin, some fragmented metopes from Selinunte. His efforts are now on display in the Museo regionale.
Towards the end of 1802, he was scandalised by the conditions endured by those suffering from tuberculosis, leprosy and severe mental illness – they were all bundled together and essentially forgotten about within the confines of the Ospedale di S. Giovanni dei Lebbrosi. Eventually the patients with mental health issues were transferred to the building of the ex-noviziato dei Padri Teresiani ai Porrazzi where Baron Pisani took over the running of the institution in 1824, transforming it into the aforementioned Casa Real. He encouraged therapies that promoted recreational activities and entertainments, even instituting an early form of occupational therapy. He was very open to ideas promulgated by cutting-edge doctors specialising in psychiatric matters. Patients were not confined to cells if this could be avoided; they were urged to walk in the gardens and participate in the cultivation of food crops that would then be used in the organisation’s kitchens.
Attention was paid to hygiene and clothing, pride in the appearance being considered important. Pisani was careful to construct an ordered and planned existence for his patients in the belief that a structured day was beneficial, thus avoiding unexpected intrusions which could lead to chaotic outbursts. Music was used as a calming influence, presaging the ‘Mozart Effect’ by many years. Poetry was also read to gatherings of those housed in the building, the verse and metre chosen to soothe the mind and stimulate thoughts in a productive manner. Pisani’s system classified patients rather than placing them all in one simplistic category. Although his groupings were stridently named to modern ears, i.e. maniac, it is interesting to note he had a category for the malinconici (those suffering from melancholy), or in today’s terminology, depression.
The outside world only began to encroach on the residents when they were sufficiently improved to warrant the prospect of release. It was at this point that Pisani considered allowing visits from relatives, believing they could then sustain contact with people and events beyond the walls. It was also a preparation for their future life outside the institution. News of Pisani’s efforts began to filter through to a wider audience. In 1835 an article was reproduced in The Friend, an American magazine, which quoted from a US surgeon’s visit to the Casa Real. The enlightened regime was witnessed at first hand:
The tranquil patients or subjects were put at work of some kind. This was and is yet the only medicinal means employed, if it may be so termed, except in cases where some physical disease is manifested. As reason is restored, and when they become capable, they are employed in various useful and responsible little offices in the house. This is found to soothe their irascibility in some instances, and in many to rouse their ambition and self esteem.
The American medic also noted that meticulous archival records were kept and the institution employed an abundance of staff who had to follow the rules: ‘Conciliatory persuasion and gentle means only are permitted to be used, the infamous use of the whip is not only abolished, but all harsh abuses and violent language and epithets are constantly rejected and carefully avoided.’ Restraints and straight-jackets were used, but only in extremis, and chiefly to protect the patient from harming him/herself. It would be naïve to suggest that the Casa Real was a paradise of insight, but by any standard of judgement applicable at the time, Pisani was light years ahead of most similar organisations.
Alexander Dumas, who knew Sicily well, was moved to refer to him in his classic, The Count of Monte Cristo:
“Do you know with what design M. de Monte-Cristo purchased a house at Auteuil?”
“Certainly, for he told me.”
“What was it, sir?”
“To make a lunatic asylum of it similar to that founded by the Count of Pisani at Palermo.”
“Do you know that edifice?”
“I have heard of it.”
“It is a magnificent institution.”
Likewise, Edgar Allan Poe was inspired by reading of Pisani in The Metropolitan Magazine. Poe also knew the author of the article, Nathaniel Parker Willis. As with all things Poe, the story he wrote: ‘The System of Doctor Tarr and Professor Fether’, had a rather sideways and edgy slant. The fictional insane asylum he features, located in France, used to have a ‘soothing’ regime which was then replaced by a stricter and harsher system implemented by the eponymous Tarr and Fether, a none too subtle reference to mediaeval punishments. Undoubtedly, the author of ‘The Pit and the Pendulum’, intended his story to satirise the prevailing cruel practices found in many North American institutions.
Pietro Pisani has spanned the decades with his reputation and ideas intact. For those wishing to know more, Germana Agnetti and Angelo Barbato have written a biography of the man and a history of the home, Il barone Pisani e la Real Casa dei Matti, published by Sellerio.
Andrew and Suzanne are authors of Ghosts of the Belle Époque, a history of Palermo’s Hotel delle Palme and Sicily: A Literary Guide for Travellers. The Times Literary Supplement had this to say about their literary guide: ‘Sicily is full of such delicious anecdotes: it is not only a literary signpost for travellers in an ancient island, but a cultural guide for anyone who finds themselves in the infuriating thrall of its contradictory and compelling extremes… Sicily is bound to become battered and dog-eared, blotched with caponata and wine stains’.
In addition, they are the authors of His Master’s Reflection, a travel biography in the footsteps of Lord Byron’s doctor and Andalucia: A Literary Guide for Travellers. Andrew is the translator of Agony, Sicily’s first detective procedural by Federico de Roberto and Borges in Sicily by Alejandro Luque, a travelogue in search of the photographic locations used by Ferdinando Scianna when he took images of the Argentinean writer, Jorge Luis Borges, during his island tour.