Forensic psychiatry and the birth of the criminal insane asylum in modern Italy

International Journal of Law and Psychiatry 37 (2014) 117–126

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International Journal of Law and Psychiatry

Forensic psychiatry and the birth of the criminal insane asylum in modern Italy 1

Mary Gibson Department of History, John Jay College of Criminal Justice, City University of New York, 524 W. 59th Street, New York, NY 10019, USA

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Available online 25 October 2013 Keywords: Law Psychiatry Hospital Italy Lombroso Criminology

a b s t r a c t This paper focuses on the creation of the criminal insane asylum in Italy between unification in 1861 and World War I. The establishment of criminal insane asylums was a triumph of the positivist criminology of Cesare Lombroso, who advocated for an institution to intern insane criminals in his classic work, Criminal Man (1876). As a context for the analysis of the birth of the criminal insane asylum in Italy, this essay also outlines the history of the insanity plea in Italian criminal law and the young discipline of psychiatry during the fifty years after Italian unification. © 2013 Elsevier Ltd. All rights reserved.

1. Introduction On May 8, 1924, the internationally renowned criminologist Enrico Ferri brought a group of students from the University of Rome to visit the criminal insane asylum of Aversa outside of Naples. According to the report on his visit sent by the director of the asylum, Filippo Saporito, to the Ministry of Justice, Ferri and his students were first taken “to observe the spectacle of a large number of patients of every legal category and of the most varied psychological types—from apparently healthy to mentally ill—involved in work that was useful both to them and to the prison administration.”2 The visitors then toured the entire institution, stopping periodically to discuss specific patients and “their psychopathologies as revealed by their rooms, their clothing, and their manual and intellectual pastimes” as well as to see the “scientific laboratories” for the clinical study of these same patients. At the end of his visit, Ferri signed the required register and noted the great progress of the criminal insane asylum of Aversa toward reconciling “the need for social defense with that for human compassion.”3 The Director proudly attached a copy of these favorable comments to his report to the Ministry of Justice as well as an article from a Neapolitan newspaper on Ferri's visit. According to the newspaper, Ferri lectured during the tour of Aversa on “the concepts and postulates of the positivist school [of criminology]” and declared himself “delighted to see, in the evening

E-mail address: [email protected]. Tel.: +1 212 237 8818; fax: +1 212 237 8830. 2 Archivio Centrale dello Stato (ACS), Ministero di Grazia e Giustizia (MG&G), Direzione Generale (DG) Istituti di Prevenzione e Pena, Archivio generale, Atti amministrativi, 1924– 25, busta 974. 3 ACS, MG&G, DG Istituti di Prevenzione e Pena, Archivio generale, Atti amministrativi, 1924-25, busta 974.

of his life, the germination of the seeds of his ideas and the affirmation of his theories and his methods.”4 As this anecdote demonstrates, the history of forensic psychiatry in Italy cannot be written without placing at its center the Positivist School of Criminology, which was presided over by the towering figure of Cesare Lombroso flanked by his two most illustrious followers, Ferri and Raffaele Garofalo (Frigessi, 1985; Gibson, 2002; Villa, 1985). Although Lombroso exaggerated when he claimed, in the preface to the second edition of his classic text Criminal Man, that he had been the first to apply scientific methods to the field of psychiatry, he nevertheless set the terms of debate about the role of forensic psychiatry in Italian law, courtrooms, and mental hospitals during the late nineteenth and much of the twentieth century (Lombroso, 2006, pp. 99–100). His prestige was so great, his writings so voluminous, and his efforts to institutionalize his ideas so tireless that psychiatrists and jurists during his lifetime had to proclaim an allegiance to either the traditional “classical school” of penology, which traced its roots back to the Enlightenment thought of Cesare Beccaria, or to the “positivist school” of Lombrosian criminology. Arguing that Beccaria's philosophical defense of free will was outdated, Lombroso instead pointed to the central role of biological determinism in criminal behavior. By counting the physical and psychological anomalies that were thought to constitute signs of atavism and degeneracy, criminologists could now turn their field into an empirical, statistical science. After Lombroso's death in 1909, lines began to blur between the two schools but many of his ideas were

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0160-2527/$ – see front matter © 2013 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.ijlp.2013.09.011

4 ACS, MG&G, DG Istituti di Prevenzione e Pena, Archivio generale, Atti amministrativi, 1924-25, busta 974. The article, titled “L'on Ferri ad Aversa con gli studenti della Scuola d'applicazione giuridica-criminale,” was published in the prominent Neapolitan newspaper Roma on May 11, 1924. For another positive evaluation of Aversa from the same period, see Rusticucci, 1918 .

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redeployed by fascist administrators under new names and for purposes that he might not have approved. Only after World War II was the biological character of Italian psychiatry successfully challenged, although some remnants of positivism remain even in current criminal law. Despite Lombroso's fame as the “maestro” of the positivist school, which was proudly labeled the “Italian school” in his native country, his theories did not go unchallenged and therefore shaped only certain policies toward the identification and treatment of insane defendants in criminal courts. The majority of Italian judges and jurists have always remained loyal to the classical school, which taught that criminals break the social contract out of free will and therefore deserve punishment. This principle underlay the legal definitions of insanity in the penal codes of liberal and fascist Italy, although it was attenuated under the Rocco Code of 1930, which is still in effect. The influence of the positivist school was strongest in two other areas: the re-definition of the insane criminal as an individual marred by constitutional or degenerate physical and psychological abnormalities; and the shaping of a new institution, the criminal insane asylum (manicomio criminale) for the treatment of mentally ill criminals. In addition to the rift between the classical and positivist schools, the Italian history of forensic psychiatry is also complicated by the diversity of the large group of doctors, lawyers, sociologists, and criminologists who identified themselves as disciples of Lombroso. On the one hand, the strength of the positivist school came from its size; for example, Lombroso listed 68 collaborators in the first issue of his journal, Archives of Psychiatry, Criminal Anthropology, and Penal Sciences, in 1880, a number that climbed to 107 ten years later.5 Such a large group was able to extend its tentacles, and therefore Lombroso's ideas, into many areas of Italian public life as it included administrators of police, prisons, mental hospitals as well as lawyers, jurists, and members of parliament. On the other hand, most adherents to positivism never followed Lombroso blindly, but critiqued certain aspects of his thought or developed new branches of it after his death. Thus it is misleading to represent positivism as a unitary school identified solely with Lombroso or to label Italian psychiatry in general as narrowly Lombrosian. But because of his preoccupation with crime—both as a theoretician and as a prison doctor—Lombroso dominated the development of specifically forensic psychiatry during the liberal period following Italian unification in 1861, and his followers remained in positions of power under fascism. This article focuses on the clearest triumph for positivism in the field of forensic psychiatry between Italian unification and World War I: the creation of the criminal insane asylum. Strengthened and expanded under fascism, this institution outlived the famous and radical “Basaglia law” in 1978, which ordered the closure of all “civil” mental institutions in Italy.6 Yet criminal insane asylums—now called “judicial psychiatric hospitals” (ospedali psichiatrici giudiziari or OPG)—have continued to operate into the twenty-first century, still under the jurisdiction of the prison administration. Only in 2012 did parliament finally pass a law to close the OPGs within a year and replace them with some type of medical unit whose form has not yet been specified.7 As context for this analysis of the birth of the criminal insane asylum, the first two sections of this paper outline the history of criminal law and the young discipline of psychiatry during the first fifty years of Italian unification.

5 Some of these were foreign scholars, showing Lombroso's international reputation. The Archives changed its title periodically, at times substituting neuropathology and/or legal medicine for penal sciences. “Psychiatry” and “criminal anthropology” remained constant in its title, showing their centrality to Lombroso's enterprise. 6 “Civil” asylums, also called “common” asylums, are regular mental hospitals in which patients are admitted under civil law or voluntarily. The “Basaglia law” is the popular label for the Legge 13 maggio 1978, n.180, which was the result of a long and passionate campaign by the psychiatrist and asylum director, Franco Basaglia. 7 Art. 3-ter of Decreto Legge 22 dicembre 2011, n. 211 confirmed by Legge 17 febbraio 2012, n. 9. The new law does not clearly indicate what type of institution will replace the OPGs. For the text of these two laws, see http://www.sanita.ilsole24ore. com/Sanita/Archivio/Normativa%20e%20varie/LEGGE%20CARCERI%20CON%20OPG. pdf?cmd=art&codid=26.1.61982420 (accessed July 15, 2012).

Next, a legislative history of the establishment of the earliest criminal insane asylums is followed by a social portrait of their inmates and their daily experience. Born out of an impulse to both discipline and cure, these new institutions embodied the contradictory nature of positivist psychiatry. Before World War I, the humanitarianism of early psychiatrists and the liberalism of the parliamentary regime tempered their potential for abuse. Under fascism, the regime introduced “security measures” against “dangerous” persons and the institutionalization of ever wider sectors of the population, including the mentally ill, in the name of social defense. These repressive policies survived the founding of the Italian Republic in 1946 and have still not been fully dismantled today. 2. Criminal law and the insanity plea According to Vincenzo Manzini, the author of an authoritative and much reprinted textbook on criminal law, the traditions of both Canon law and the statutes of the medieval Italian states recognized insanity as an impediment to punishment as early as the thirteenth century. He thus pronounced early Italian law to have been superior to that of Germany, which was “crude” in its refusal take mental condition into account in legal proceedings (Manzini, 1981, v. 2, p. 112). However, medieval and early modern courts often failed to enforce this legal exemption from punishment for the insane, with witches constituting the prime example in the writings of nineteenth-century liberal jurists bemoaning past legal injustices. After the defeat of Napoleon in 1815, many of the restoration states in Italy, most notably the Kingdom of Piedmont, retained some version of Article 64 of the French Penal Code (1810), which absolved defendants who, at the time of their crime, were insane or compelled by an irresistible force. After unification in 1861, the Italian parliament passed no new criminal code until 1889, thus failing to set clear and unified judicial guidelines across the peninsula. The main stumbling block to parliamentary action was a sharp debate over the death penalty, but the question of legal responsibility was also divisive. Thus, until 1889, two different criminal codes co-existed within the new nation: the Piedmontese code of 1859 and the Tuscan code of 1853. The former was extended to the majority of provinces as they were liberated and voted to put themselves under the rule of King Victor Emanuel II of Piedmont. Only the region of Tuscany held out against this process of “piedmontization” because local statesmen contended that their penal legislation, which had abolished capital punishment, was more progressive and therefore superior to that of Piedmont. Both codes included extenuated punishment for the insane, but on different grounds. According to Article 94 of the Piedmontese code, “no crime exists if the accused was in the condition of absolute imbecility, insanity, or morbid fury when he committed the act or if it is a question of a force which he could not resist” (Codice Penale per gli Stati di S. M il Re di Sardegna, 1882, p. 37). Article 34 of the Tuscan code was simpler, shielding from indictment anyone who had acted without “consciousness of his acts or freedom of choice” (Miletti, 2007, p. 323). For almost thirty years, until the passage of the so-called Zanardelli Code in 1889, lawyers and psychiatrists argued over the merits of each definition and the appropriate wording for a new national definition of legal responsibility. To a great extent, the participants in this debate broke down into two factions: those who upheld the traditional eighteenth-century principles of the “classical school,” which stressed the centrality of free will, and those who supported the new “positivist school” that traced the etiology of serious crime to biological and psychological determinism. The classical school was composed predominantly of lawyers, most notably Francesco Carrara, Luigi Lucchini and Enrico Pessina, who accepted the need to exempt the insane from indictment, but believed that judges should retain control of such decisions. The positivist response came mostly from psychiatrists, led by Lombroso and Augusto Tamburini joined by jurists such as Ferri and Garofalo. They supported a medical definition of assessing legal

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incapacity that would require the expertise of psychiatrists in the judging of each individual case.8 A lively and sometimes acrimonious public debate was waged in scholarly journals, academic conferences, and parliament about the exact definition of insanity to be incorporated into a new criminal code. The classical school held criminal behavior to be voluntary and therefore excusable only when reason and free will were compromised. Its proponents held to a circumscribed definition of insanity, typical of the early nineteenth century, as a delirium that interrupted the proper functioning of intelligence. The positivist school was more expansive, preferring a medical definition of insanity that could include a variety of conditions arising from either inborn constitutional defects or degenerative disease. Led by Ferri, who was the first to develop a sustained legal critique of free will, positivists denied that criminals were morally responsible for their antisocial behavior, which they argued was rooted in biological, psychological, or—in the case of occasional criminals— social factors (Ferri, 1881). Such a radical rejection of one of the fundamental pillars of Italian law—the voluntary nature of crime—did not, however, preclude punishment, which positivists held was necessary for social defense. While psychiatrists were not certain how to distinguish crime from insanity, they agreed that medical rather than legal expertise was needed in the courtroom to determine the liability of each defendant to punishment. Positivists therefore wanted the article of the new code pertaining to mental capacity to adhere more closely to the Piedmontese wording, with its medical terminology, while the classical school championed instead the Tuscan code with its philosophical language. In the end, the Zanardelli code of 1889 struck a middle course between the Piedmontese and Tuscan codes. According to Article 46, a defendant was not “punishable” if “at the moment in which he committed the act, he was in such a state of mental illness that he was deprived of consciousness or freedom of action” (Il Nuovo Codice Penale Italiano, 1890, p. 86). Such a formulation retained the enlightenment notion of free choice, fundamental to the Tuscan code, and excluded the list of specific mental incapacities found in the Piedmontese code. Thus this article, as well as the Zanardelli Code in general, has been judged by most legal historians as a triumph of the classical over the positivist school. However, Article 46 offered a few openings to proponents of the new psychiatry. By employing the term “punishable” rather than the more common “indictable,” the authors of the code avoided a word that, in Italian, has a close association with the philosophical notion of individual responsibility. Furthermore, the term “mental illness” was broad enough to include “any state of mind which, straying from a normal equilibrium, could constitute mental illness whether congenital or acquired, habitual or transitory” according to Antonio Raffaele, a Neapolitan forensic doctor (Miletti, 2007, p. 324). Thus he and many other positivists interpreted Article 46 as only a partial defeat, because the law left room for an evolution of the definition of “mental illness” in tandem with psychiatric advances. Notably absent from Article 46 was any mention of “morbid fury” or “irresistible force,” conditions expressly listed in the Piedmontese code as a type of insanity. According to Manzini, by the late nineteenth century, the “irresistible force” of emotions was no longer considered a sign of mental illness and therefore held to be inadequate for excusing criminal behavior (Manzini, 1981, v. 2, p. 116). Only violent passions arising from a morbid state, such as epilepsy, could constitute grounds for the denial of legal responsibility. However, the old notion of irresistible force was not dropped from the code but instead enshrined in Article 51, which reduced punishment for anyone who acted “in an outburst of anger or from intense pain caused by an unwarranted provocation” (Il Nuovo Codice Penale Italiano, 1890, p. 93). As the noted jurist Pessina explained in his annotations to the code, this rather vague article most often referred to violent male crimes provoked by the seduction or rape of wives and daughters, although it gave wide latitude to judges 8 Augusto Tamburini (1848–1919) was appointed director of the civil asylum in Reggio Emilia in 1877 and to the chair of psychiatry at the University of Rome in 1905. He was best known for his study of aphasia.

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to consider other provocations as equally worthy of excusing violent reactions (Il Nuovo Codice Penale Italiano, 1890, pp. 93–94). Thus in a contradictory manner, the Zanardelli Code managed to update its definition of insanity in Article 46 while re-enforcing one of the most traditional aspects of Italian law, the mitigation of punishment for “crimes of honor,” in Article 51. Psychiatrists were similarly ambivalent about Article 47 of the Zanardelli code, which allowed the judge to reduce penalties in the case of diminished mental capacity. This recognition of partial insanity appeared an absurdity to many psychiatrists, whose biological model taught that constitutional atavism and degenerative disease affected the entire organism, including the mind. Furthermore, their rejection of free will denied the possibility of semi-responsibility on the part of defendants (Tamassia, 1890, pp. 11–12). However, parliament spent little time discussing this article, perhaps because a similar provision had been included in both the Piedmontese and Tuscan codes (Article 95 and Article 64 respectively). For classical jurists, humanitarianism required a middle position or else, in the words of Carrara, judges would find themselves caught “in the terrible crossroads between the gallows and absolution” (Babini, 1982, p. 140). Again, while criticizing the notion of partial insanity in theory, psychiatrists realized its practical value in expanding their role in the courts. This role consisted primarily in giving expert testimony (perizia) on the sanity of defendants as outlined in the Code of Criminal Procedure (CCP). Because the CCP regulated the conditions under which psychiatrists were allowed access to the courtroom, Ferri pronounced it more important than the criminal code to the positivist goal of recasting punishment as an arm of social defense rather than of retribution (Miletti, 2007, p. 322). According to the CCP of 1865, which was passed soon after the declaration of the new Italian state, experts might be called to testify during both the preliminary investigation (istruttoria) and the trial (dibattimento), but according to different rules. During the preliminary investigation, which was closed to the public, only the judge had the right to nominate and question psychiatric experts. According to Marco Nicola Miletti, positivists were most interested in changing this phase of the judicial procedure because judges were thought to lack the medical expertise to choose specialists who were trained in the latest criminological theories. As an alternative, psychiatrists called for the nomination of experts based on qualifying examinations (Miletti, 2007, p. 330). During the early decades after unification, most psychiatrists were less interested in appearing in open court during the trial, because of the sensationalist nature of the exchanges between experts chosen by the prosecution and the defense. By the end of the nineteenth century, however, with increasing journalistic and public interest in courtroom drama, psychiatrists learned to use this public phase of the trial as a mechanism for advertising new advances in psychiatry and its relationship to legal responsibility. Expert testimony in famous trials—often reprinted in newspapers, journals, and books—became, in the words of Renzo Villa, “the true public face” of psychiatry in late nineteenth-century Italy (Villa, 1982, p. 385). Despite their limited authority within the courtroom, psychiatrists honed their skills by publishing a series of guides for the expert witness. The most famous was written by Lombroso, who counseled his readers to: gather the results of tests on height, weight, and urine, of the examination of general anthropological characteristics, of the skin and cutaneous processes, of the skull, limbs, etc., then the data on sensitivity to weather, to touch, to pain, to drugs, on affectivity and emotionality, on feelings, [and] on the association of ideas…so that, in the end, based on all these characteristics, you can offer a synthesis that will illuminate the judge. [(Miletti, 2007, p. 335)] Other guides were written by lesser-known practitioners of legal medicine such as Raffaele, whose Practical Guide to Expert Testimony

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exhorted his colleagues to include a case history, physical measurements, and a psychological examination based on an interview and hand-writing analysis. For both authors, mind and body were so closely linked that physical anomalies became clues to mental instability. Expert testimony based on these positivist assumptions did not always convince judges, as in the famous case of Carlo Grandi, arrested in 1875 for the murder of four children. His trial became an early example of the increasingly frequent courtroom duels between the classical and positivist schools. Led by the young Enrico Morselli, a disciple of Lombroso, the team of expert witnesses for the defense declared Grandi to be a congenital imbecile marked by multiple physical and psychological anomalies, and therefore not responsible for his violent behavior.9 The prosecution, however, won a conviction by arguing that Grandi's skills as a cartwright and his premeditation of the murders (he dug graves in advance) proved his ability to reason and distinguish right from wrong (Guarnieri, 1993). Although further research is needed to determine how often positivist testimony was successful in overturning the traditional classical principles in the courts, even the failed attempt in the Grandi case brought the new fields of psychiatry and legal medicine to public attention. As in other European countries, crowds jostled to get seats at notorious trials and newspapers printed daily reports of the proceedings (Colao, Lacchè, & Storti, 2008). Thus, Italy's legal system developed along a dual track, with classical principles dominating penal law but positivist theories reigning among psychiatrists and criminologists. It was in these new fields of knowledge that Lombroso and his followers had their greatest influence both as theorists and as administrators in the growing network of institutions—including mental hospitals and prisons—that comprised an important aspect of Italy's consolidation as a nation. 3. Psychiatry and criminology While Ferri led the positivist campaign among lawyers to modify the legal codes, Lombroso was more influential in setting the agenda for Italian psychiatrists. This is not to say that Lombroso ignored the debates on criminal law, a subject that he treated both in an early book on public policy, On the Increase of Crime in Italy, and in the successive editions of Criminal Man (Lombroso, 1879, 2006). Yet as a doctor trained at the universities of Padua, Pavia, and Vienna, Lombroso saw himself first as a pioneer in the relatively new field of psychiatry and later as the founder of criminal anthropology. In the humanitarian spirit of the mid-nineteenth century, he focused his early research on cretinism and pellagra, two diseases that ravaged the physical and mental health of the agricultural poor (De Bernardi, 1980). As an Italian patriot, he served in the Piedmontese army that fought for Italian unification. Before gaining a permanent academic post in legal medicine at the University of Turin in 1876, he served as director of the insane asylum in Pesaro. Thus Lombroso was not only a university professor but also dealt with the practical management of a mental institution. In Pesaro he perfected his empirical method of collecting immense amounts of data on the biological and psychological characteristics of inmates for the purpose of better understanding the signs and causes of mental illness. Using the same approach to study criminals, Lombroso initially concluded that they formed a distinctly separate group from the insane. In the first two editions of Criminal Man, he used his statistical data on the insane as a control group for born criminals, whom he found to harbor more physical anomalies. For Lombroso, this relative absence of atavism among the insane confirmed his assumption that their disease was transitory and liable to cure (Lombroso, 2006, p. 48). Born criminals, on the other hand, were congenitally atavistic and therefore permanent throwbacks on the evolutionary scale. He thus resisted the common prejudice that the mentally ill as a group were dangerous. By the third 9 Enrico Morselli (1852–1929) served as the director of the civil asylum of Macerata and later of the psychiatric clinics at the Universities of Turin and Genoa.

edition of 1884, however, Lombroso admitted that new research on moral insanity had persuaded him that the line between insanity and criminality was more blurred than he had previously thought (Lombroso, 2006, p. 213). Like atavism, moral insanity was incurable and posed a dire threat to society. He soon added epilepsy to the mix, arguing in the fourth edition that: the difference among epilepsy, moral insanity, and born criminality is only a matter of degree…Overall, the three phenomena are similar, and since two things that resemble a third thing are therefore identical to each other, it is clear that congenital criminality and moral insanity are nothing but special forms of epilepsy. [(Lombroso, 2006, pp. 263–264)] In the same edition, he also included new types of insane criminals: the alcoholic criminal, the hysteric criminal, and the mattoid, a religious or political megalomaniac. By multiplying the categories of the insane criminal, Lombroso laid the theoretical grounds for acquitting an increasing number of defendants.10 Lombroso's elaboration of the insane criminal was daring in its scope, but at the same time consistent with the generally organicist stance of early Italian psychiatry (Fiorino, 2002; Guarnieri, 1991; Tagliavini, 1985). This materialist approach was not unusual in nineteenthcentury Europe, but was less contested and more long-lived in Italy, where scientists had to battle traditional Catholic hegemony over intellectual life. Not yet an autonomous discipline in 1839, when scientists from across the peninsula had begun to hold congresses for the purpose of setting an Italian agenda of research, psychiatry gradually separated itself from general medicine and philosophy. In 1852, Andrea Verga, considered the father of Italian psychiatry, founded The Psychiatric Appendix, the first periodical dedicated to mental diseases (Agnetti and Barbato, 1982).11 Verga and other pioneers in this new field began to meet in 1862 as a special section of the annual scientific congresses until they formed their own independent association, the Italian Society of Phreniatry, in 1873. Dedicated to positivism in its general sense, that is, the application of experimental methods, the new Society sought to turn Italian psychiatry into a science. Thus, Lombroso's call for a new criminal anthropology, based firmly on positivist foundations, found fertile ground as psychiatry sought to define its role in the new Italian nation. Not all of his colleagues accepted his grandiose and ever expanding theory in its entirety, with atavism drawing frequent criticism. But disagreement among psychiatrists was not unusual and characterized many initiatives, such as the failed attempt to draw up a national classification of mental diseases. By the early twentieth century, a young group of psychiatrists began to champion the new clinical methods of Emil Kraepelin, while Leonardo Bianchi split off from the phreniatric society in 1907 to found the Italian Society of Neurology (Babini, 2009).12 As a group, however, Italian psychiatrists remained essentially wedded to a biological approach that echoed Lombroso's call for social defense against the morally insane, epileptics, and other carriers of constitutional or degenerative defects. Even more consensus existed on the need for a new institution, the criminal insane asylum, for which Lombroso initiated a campaign in 1865 that continued throughout the five editions of Criminal Man (Lombroso, 1865; Lombroso, 1872). For the insane criminal, Lombroso argued that “liberty is dangerous, but prison would be unjust” (Lombroso, 2006, p. 146). Because the law gave no guidance in such cases, “judges rule unjustly or imprudently. When madness is obvious,

10 More research is needed to ascertain how many defense lawyers used these categories in criminal court to successfully shield their clients from conviction. 11 Andrea Verga (1811–1895) became director of the civil asylum “della Senavra” in Milan and was nominated to the Italian Senate in 1876. 12 Leonardo Bianchi (1848–1927) held the chair of psychiatry and later the Presidency of the University of Naples; served as the director of the Neapolitan civil asylum of San Francesco di Sales; was elected a member of the Chamber of Deputies (1892); and appointed Minister of Education (1905).

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they acquit or reduce the punishment. But just as often they convict, even applying the death sentence” (Lombroso, 2006, p. 147). The answer was the criminal insane asylum which would combine the security of a prison with the therapy of a mental hospital. In answer to critics who worried that criminals would escape punishment by employing the insanity defense, Lombroso denied that he was motivated by “a sentimental pity that might threaten the well-being of others. Criminal insane asylums are more a precautionary than humanitarian measure” since they would have the power to intern insane criminals until cured (Lombroso, 2006, p. 148). Lombroso's campaign for the establishment of criminal insane asylums fitted into the wider program of the psychiatric community, which supported internment as the primary response to problem of mental illness (Babini, 1981; Martucci & Corsa, 2006; Villa, 1980). Like schools and hospitals, modern asylums were a necessary tool to “make Italians,” that is, to construct a new Italian citizen through humanitarianism and discipline.13 Thus the number of public asylums increased from 27 in 1866 to 43 in 1898 and finally 59 in 1918, with overcrowding always a major problem (Babini, 2009, p. 10; Cotti, 1982; Tagliavini, 1985, p. 178).14 Medical directors of civil asylums were often prominent psychiatrists who also held university chairs, and they tirelessly conducted studies of the physical and psychological characteristics of their patients. Yet this same positivist approach, which denied the existence of a mind separate from the body, meant that they spent little time with their patients and were resistant to new clinical techniques developing elsewhere in northern Europe. Instead, they believed that the best therapy derived from the isolated and moral environment of the asylum, with its hygienic atmosphere, frequent baths, and the discipline of work. In 1904, a new national law on mental asylums finally standardized rules for the treatment of the mentally ill across the nation. Before that, legal and institutional arrangements differed widely throughout the peninsula, with procedures for admission and conditions within asylums depending on local regulations and funding.15 The Law of 1904 continued to leave financial support of civil asylums to the provinces but standardized the procedure for forced admittance, which could be initiated by relatives, judicial authorities or, in an emergency, by the police. Most notoriously, the law established “dangerousness” and “public scandal” as the major grounds for admission, criteria that have been criticized by many historians as buttressing the popular stereotype of the madman as a social threat.16 It also gave psychiatrists almost total control of mental hospitals, a step that was cheered as a victory by asylum doctors who bemoaned previous disputes with non-medical administrators over funding. Some proponents of the classical school, however, worried about the rights of patients who were now left at the mercy of possibly dictatorial physicians. Positivist theory clearly influenced the development of mental health policy in Italy, with its increasing reliance on institutionalization for treatment and the emphasis on dangerousness as the primary criterion for admittance. Lombroso and his allies also lobbied hard to place direction of asylums in the hands of doctors, something that might have been impossible without the acceptance—even by many classical jurists—of the innovative and important role of psychiatric knowledge. The triumph of positivism was not complete, as the Law of 1904 continued to allow home care by offering subsidies to poor families for taking in the mentally ill (Guarineri, 2007). Yet on balance, national guidelines 13 The Italian patriot and statesman, Massimo D'Azeglio enunciated the famous pronouncement after unification that “Italy has been made; now it remains to make Italians.” 14 The number of private asylums increased even more dramatically, from 5 in 1866 to 19 in 1898 to 30 in 1918. 15 Articles 172 and 174 of the Legge communale e provinciale, 20 marzo 1865, n. 2248 held the provincial governments financially responsible for the upkeep of asylums and the care of the mentally-ill poor. 16 Legge 14 febbraio 1904, n. 36 also allowed for admission of non-dangerous individuals if the asylum had empty beds. The procedures were spelled out more clearly in the Regolamento 16 agosto 1909, n. 615, which implemented the 1904 law.

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emphasized the role of civil asylums as guardians of social order, a role even more central to their criminal counterparts.

4. Criminal insane asylums: legislation Lombroso was joined by other psychiatrists such as Gaspare Virgilio, Serafino Biffi, Carlo Livi, and Augusto Tamburini in lobbying parliament for legislative approval for criminal insane asylums.17 They argued that such institutions would strengthen the young and fragile nation and bring its social policy into line with England, Ireland, France, Germany and the United States, where special facilities for the criminally insane had already been established. This appeal to the merits of criminal insane asylums for state-building rested on two important but sometimes contradictory principles of criminal anthropology. On the one hand, positivists argued that the internment of dangerous criminals—including the criminally insane—would protect Italy from enemies of the state that included not only brigands and mafiosi in the Southern provinces, but also atavistic criminals from all regions. Embarrassed and frightened by Italy's high rates of violent crime, legislators should welcome an institution where professional psychiatrists used their expertise to identify born criminals and intern them for life.18 On the other hand, criminal insane asylums would illustrate Italy's commitment to liberal reform by rescuing insane criminals from penitentiaries and offering them medical treatment. Imbued by a social conscience that led most of them to membership in the Italian Socialist Party, positivist criminologists exhibited a humanitarian impulse toward the criminally insane that often co-existed uneasily with their passion for social control. Tamburini, an eminent psychiatrist who became the director of the civil asylum in Reggio Emila in 1877, was Lombroso's prime collaborator in the campaign for the new institution. His description of the ideal criminal insane asylum of the future explicitly recognized its contradictory role as both a defense against social disorder and a progressive hospital for benevolent cure. According to Tamburini, the new institution would have to reconcile both “the discipline of the prison and security of a fortress with the comfort of a family, offering all possible security against the dangers posed by these patients as well as a most attentive and affectionate treatment of the diseases that make them dangerous” (Tamburini, 1873, p. 47). Citing the English asylum of Broadmoor as an example, he recommended a militarized staff of guards to watch over inmates who, during the day, would be divided into small groups according to their degree of dangerousness and, at night, would sleep in separate cells. He promised that inmates would enjoy “fresh air under the open sky with access to meadows, gardens, the vital warmth of the sun, and purity of an air invigorated and perfumed by plants and flowers” (Tamburini, 1873, p. 48). Work, schooling, and recreation would complete their therapy with the goal of “restoring disciplined behavior and curbing their impulses, even those arising from disease” (Tamburini, 1873, p. 48). To accomplish these multiple and often conflicting goals, Tamburini insisted on the need for new buildings rather than the conversion of older and ill-adapted structures. Even staunch opponents of Lombroso, including Lucchini and Carrara, were amenable to the establishment of criminal insane asylums for certain groups of offenders. Debate centered on three legal categories of possible inmates for such institutions: convicted criminals who became insane in prison; suspects in jail who became insane while awaiting trial; and defendants acquitted on the grounds of insanity. Agreement was strongest on the suitability of an alternative to incarceration for the first group, convicted criminals who became insane after sentencing. Lively debate occurred over whether prison itself—or 17 Carlo Livi (1823–1877) served as director of the civil asylums of Siena and Reggio Emilia and as well as the psychiatric clinic at the University of Modena. 18 Although Italy's rate of violent crime was high among European nations, it tended to fall after unification in contradiction to the hysterical warnings of positivist criminologists (Gibson, 2002, 12–13).

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specifically the Philadelphia system of solitary confinement—caused insanity. Yet positivists and classicists agreed that mentally-ill inmates deserved treatment and therefore transfer to some type of hospital as long as they were released at the end of their sentence. The two criminological schools were in less accord over the second category, inmates of jails who became insane while awaiting trial. According to positivist logic, such individuals should be admitted to criminal insane asylums for observation and, if found to harbor atavism, moral insanity, or epilepsy, be interned indefinitely. Members of the classical school held all persons awaiting trial to be innocent and therefore not subject to admission to a mental hospital, particularly one that could hold patients indefinitely. Concern over individual rights also shaped attitudes to the third group, defendants acquitted on the grounds of insanity. For classicists, the state had no right to incarcerate anyone not charged with a crime, even in a hospital, while positivists again argued that only their expert opinion could separate the born criminals from the innocuous neurotic or imbecile defendant.19 Lombroso and his followers believed that born criminals, even if acquitted, should be interned indefinitely in the name of social defense. Because of such differences, the incorporation of the criminal insane asylum in legislation came slowly despite the unanimity among psychiatrists for its need. At its first congress in 1876, the Italian Society of Phreniatry appointed a commission, composed of Lombroso, Virgilio, and Biffi, to study the issue. In 1881, its members were united in their support of a proposed law on treatment of the mentally ill, introduced into parliament by the Minister of the Interior Agostino Depretis, that required the establishment of the criminal insane asylum (Tamburini, 1883). When legislators failed to act on this initiative, proponents of these institutions—including both psychiatrists and positivist jurists— set their hopes on the new criminal code that had been debated for decades. Yet, they were disappointed. Although the penultimate draft authorized judges to intern defendants in criminal insane asylums, the final text of Article 46 made no specific mention of these institutions. In his commentary on the final wording of this article, the forensic physician Arrigo Tamassia lamented that “academic sentimentalism” among classical jurists, who were determined to defend their prestige, had defeated “the only serious concession to the positivist school” in the criminal code, that is, the criminal insane asylum (Tamassia, 1890, p. 13).20 All was not lost, however, because the subsequent Regulation on Prisons and Reformatories of 1891 outlined the procedures for the forced commitment of all three categories defined by positivists as requiring internment: convicted criminals and suspects who became mentally ill in prison as well as defendants acquitted on the grounds of insanity.21 Such wide jurisdiction was subsequently cut back in 1904, however, when the first national law on mental hospitals directed that only convicted criminals and the most dangerous defendants awaiting trial be interned in criminal insane asylums (Lonni, 1982).22 Despite the delays in legislative authorization, criminal insane asylums were nevertheless established as early as 1876 under the aegis of Martino Beltrani Scalia, the Director of Prisons within the Ministry of the Interior. An admirer although not a complete disciple of Lombroso, Beltrani Scalia believed passionately in the need for criminal insane asylums and propagated his views in the Journal of Prison Sciences, which 19 Reference was also sometimes made to a fourth group, those categorized as “semi-insane” who had received a reduced sentence for mental imbalance (Babini, 1981, 176–81). 20 Article 46 of the Criminal Code allowed judges to maintain in custody defendants whom they considered dangerous but who had been acquitted under the insanity defense. Later legislation specified that they must be sent to civil asylums. Arrigo Tamassia (1848– 1917) became a professor of legal medicine at the University of Pavia in 1876 and was nominated to the Italian Senate in 1909. 21 Reggio Decreto 1 febbraio 1891, n. 260, Arts. 469–80. In this law, the term “judicial insane asylum” was used, possibly to mollify classical jurists who insisted that the courts, rather than the prison administration, control the process of admission and release. It was highly unusual for a decree-law like this one, which was simply issued by the executive branch, to supercede legislation passed by parliament. Parts of this decree were indeed modified by the Law on Mental Hospitals of 1904. 22 Legge 14 febbraio 1904, n. 36.

Table 1 Crimes for which inmates were convicted (in percentages). Source: ISTAT, 1909–1914. Year

Violent

Property

Other

1909 1910 1911 1912 1913 1914

77 75 79 79 81 81

15 19 15 15 14 12

8 6 6 6 5 7

Note: Numbers are for December 31 of each year.

was issued by the prison administration under his editorship. Like Lombroso, Beltrani Scalia had been an ardent patriot during the risorgimento and sought to bring Italy's institutions of punishment into line with those of northern Europe, an effort which brought him recognition at the International Prison Congresses. He was able to take advantage of the highly centralized administrative structure of the new Italian state to establish three criminal insane asylums in the last quarter of the nineteenth century even before the concept had received definitive legislative approval. These were at Aversa, where a special “section for lunatics” (sezione per maniaci) was opened in 1876, Montelupo Fiorentino in 1886, and Reggio Emilia in 1897.23 Why did the criminal insane asylum merit such a vigorous and relentless campaign by Lombroso and his followers? Only a few historians have begun to reconstruct the birth of the criminal insane asylums in Italy, and they doubt the humanitarian motives of psychiatrists. According to Villa, the call for this new institution “did not reflect a real social necessity in terms of public order or health, or in terms of a hypothetical imperative of social defense” (Villa, 1980, p. 370). Little desired by the parliament, criminal insane asylums were championed by positivist psychiatrists because of their mania for classification and their determination to extend the power of their new profession into the judicial system. Valeria Babini agrees, although she puts more emphasis on the theoretical conundrum in late nineteenth-century Italian psychiatry of reconciling the new notion of congenital mental conditions—most notably moral insanity—with the more traditional understanding of mental illness as temporary and treatable. Thus, the creation of the criminal insane asylum offered an institutional solution that disguised continuing theoretical confusion (Babini, 1982, pp. 194–195). Another factor, I would argue, was the everyday experience of most Italian psychiatrists as physicians and directors of mental hospitals. Whatever the shortcomings of the criminal insane asylums, they promised to relieve the regular mental hospitals of unruly convicts who had been transferred from prison. As almost 80% of convicts in criminal insane asylums had committed violent crimes, psychiatrists were not necessarily exaggerating the potential problems of mixing them with other categories of the mentally ill [Table 1]. Furthermore, archival records show that civil asylums had trouble collecting payment for criminals sent for observation as well as, after 1904, defendants who had been acquitted but could no longer be sent to criminal asylums.24 After years of wrangling, the Council of State finally ruled in 1907 that the central government should pay for the initial period of observation in civil asylums, after which the provinces would pick up the cost for extended treatment, but the central prison administration continued to object.25 Thus directors of civil asylums—which were overcrowded, underfunded, and dependant on the provincial governments—had strong motives for supporting the establishment and expansion of a companion 23 Originally an annex of the civil asylum at Aversa, the section for lunatics was redesignated a full-fledged criminal insane asylum in 1890. 24 See for example, the correspondence between the civil asylum of S. Maria della Pietà in Rome to the prison administration in ACS, M. Interno, DG Carceri, Archivio generale, Atti amministrativi (1896–1905), b. 209, f. 55. Requests for payment regarded not only suspects under observation but also a prison guard who had been treated for two months. 25 See ACS, MG&G, DG Istituti di prevenzione e pena, Archivio generale, Atti amministrativi, 1906–1925, b. 25, f. 55.

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Table 2 Prison guards assigned to criminal insane asylums. Source: ISTAT, 1904–1914. Year

Commander

Chief guard

Assistant to chief

Special guard

Guard

Student guard

Inmates: guard

1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 1914

1 1 1 1 1 – – – 1 1 1

2 1 2 3 3 3 1 1 1 1 2

7 5 4 4 4 5 2 3 5 5 4

7 10 – 31 36 37 35 42 42 43 41

54 60 62 94 103 103 116 117 116 120 116

– – – – 5 14 14 8 8 6 11

10 8.9 9.7 5 4.2 4.2 4.2 4.3 4.4 4.2 4.2

Note: Numbers are for December 31 of each year.

institution that, because it was classified as a prison, would be paid for by the national state. Thus criminal insane asylums came to be seen as necessary on both practical as well as theoretical grounds. 5. Criminal insane asylums: practical conditions It is more difficult to ascertain the practical conditions in the criminal insane asylums than to understand the ideal model for their establishment. Statistics collected by the Ministry of the Interior give us a partial glimpse into the interior life of Aversa, Montelupo Fiorentina, and Reggio Emilia during their early years. Sketchy before 1900 but more consistent afterwards, these statistics were published in the annual government reports about prisons rather than hospitals, showing that security rather than medical treatment remained the state's primary goal for these institutions. Their directors were non-medical administrators until the Law of 1904 and, even after they were replaced by psychiatrists, the staff continued to be composed of militarized prison guards, rather than nurses. The ratio of inmates to guards dropped sharply between 1904 and 1914, indicating a tightening of surveillance and discipline [Table 2]. Although official statistics indicate that many fewer inmates of the criminal insane asylums than of prisons underwent punishment for bad behavior, restraint was exercised in other ways, through straps on beds, straight-jackets, and isolation cells (ISTAT, 1902–1914). The number of inmates in the three asylums grew dramatically from 118 in 1881 to 735 in 1901, after which totals remained in the range of 650–750 until World War I [Table 3]. According to the prison administration, the institutions were rarely full, housing slightly fewer patients than their official capacity in most years.26 Crowded sleeping quarters were most typical of Aversa, an old monastery outside Naples, which was ill-adapted for the individualization of treatment. Until a scandal and subsequent investigation forced the state to renovate and enlarge Aversa in 1906, each dormitory held about thirty inmates, a number that dropped to nine by 1909. In contrast, Montelupo Fiorentino placed an average of only six inmates in each dormitory, with more than 100 more enjoying a private cell for sleeping. Reggio Emilia could not boast individual cells, which were the ideal of psychiatrists, but limited each sleeping room to three inmates. All three institutions also had isolation cells for prisoners undergoing punishment or, more often, defendants awaiting trial who in theory were not to be mixed with convicted criminals (ISTAT, 1884–1914). A social profile of the inmates in criminal insane asylums reveals that they were all male, a bit older than prisoners in general, and mostly poor. The absence of any sections for women, who were relegated to penitentiaries administered by nuns, is indicative of a general 26 Renzo Villa interprets the close correlation between official capacity and the actual numbers of inmates as proof that admittance and release depended more on administrative needs than the health of inmates (Villa, 1980, 378).

disinterest by the prison administration in female inmates (Gibson, 2009). The male population of the criminal insane asylums clustered between 20 and 40 years of age, with the larger group over 30; very few were minors but significant numbers were over 50 (ISTAT, 1909– 1914). This age structure may have reflected the long sentences of most inmates. Over two-thirds were single and, even after the turn of the twentieth century, 40% were illiterate [Tables 4 and 5]. In terms of profession, the largest category of inmates came from rural areas and had been employed in agriculture or mining before admittance [Table 6]. A smaller but growing number had worked in Italy's burgeoning cities, although rarely in factory jobs because of the slow pace of industrialization. Thus most male urban workers were artisans, shopkeepers, construction workers, and servants. The number of middle-class inmates (including clerks) dropped from 11% to 4% of the total between 1894 and 1907, perhaps because the 1904 law forbade the internment of defendants acquitted by reason of insanity. Wealthy enough to hire good lawyers and private psychiatrists as expert witnesses, middle-class defendants were most likely to be acquitted and sent to civil asylums, whether public or private. Thus, the population of the criminal insane asylums—young, impoverished, badly educated, and unmarried—represented the most marginal sector of the working classes. Inmates of the criminal insane asylums were somewhat isolated, in poor health, and serving long sentences. In 1911, only a quarter of them received a visitor, a number that was even lower in the previous years (ISTAT, 1909–14). They wrote and received, on the average, 5 letters per year in 1904 though that number increased to 8 by 1913 [Table 7]. Most inmates received money from the outside, probably to buy extra food, and an average of 18% sent small sums to their families saved from their modest wages (ISTAT, 1904–1914). On the average, each inmate was admitted to the infirmary once or twice per year, while yearly rates of death were high, dropping slowly from 8% in 1901 to 4% in 1914 (ISTAT, 1901–14). By both measures, criminal insane asylums were less healthy than regular prisons. Terms of incarceration were long, with 80% of all inmates sentenced to at least ten years and infrequently enjoying early release, either through pardons or parole (liberazione condizionale) [Table 8]. If pronounced cured of mental illness, convicts were returned to regular penitentiaries to serve out the balance of their

Table 3 Number of inmates in Italian criminal insane asylums. Source: ISTAT, 1884, 1894, 1904, 1914. Year

Aversa

Montelupo Fiorentino

Reggio Emilia

Total

1884 1894 1904 1914

176 183 207 198

– 303 360 318

– 26 160 222

176 512 727 738

Note: Numbers for 1884 and 1894 are for June 30; numbers for 1904 and 1914 are for December 31.

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Table 4 Marital status on inmates in criminal insane asylums. Source: ISTAT, 1910–1914. Year

Single

Married with children

Married without children

Widower with children

Widower without child

Total

1910 1911 1912 1913 1914

452 487 511 506 514

150 142 156 147 138

58 82 64 72 63

15 11 13 11 11

20 15 11 10 12

695 737 755 746 738

Note: Numbers are for December 31.

Table 5 Educational level of inmates in criminal insane asylums. Source: ISTAT, 1908–1914. Year

Illiterate

Read only

Read and write

Elementary school

Advanced education

Total

1908 1909 1910 1911 1912 1913 1914

292 268 256 358 281 296 281

28 87 109 126 128 80 103

253 227 234 158 224 214 200

49 73 75 75 102 139 137

14 20 22 20 20 17 17

636 675 695 737 755 746 738

Note: Numbers are for December 31.

sentences; indicted prisoners sent to jails to await trial; and acquitted defendants usually transferred to a civil asylum. It was not easy to escape institutionalization. Although work—or ergotherapy, in medical terminology—was the central pillar of treatment in all Italian mental hospitals, statistics for the period preceding World War I show low rates of employment in the criminal insane asylums. On 30 June 1895, only 14% of all inmates were working, a rate that increased to 16% in 1904 and finally 23% in 1907 (ISTAT, 1894–95, 1904–07). Unlike inmates in regular penitentiaries who were often employed by private contractors, those in criminal insane asylums worked almost exclusively for the state as bricklayers, carpenters, shoemakers, textile workers, or servants. Idleness was not relieved by education, despite the ideal model proposed by Tamburini. Official statistics show no evidence of the schools and libraries found in other prisons, demonstrating that inmates received little academic or professional training for life after release. Despite the generally dismal life of a typical inmate, conditions were not static and each asylum had its own particular history. For example, a scandal at Aversa in 1905–06 provoked significant improvements. The oldest and most crowded of the three institutions, Aversa had previously served as a poorhouse and prison. In 1905, after denunciations from inmates about abuse from the staff and spoiled food, the public prosecutor of Naples opened an investigation of conditions in Aversa. In his defense, Director Gaspare Virgilio, a prominent pioneer of Italian psychiatry, pointed out that he had taken control of the institution only eight months before, in line with the Law of 1904 requiring medical administrators. He blamed his predecessor for the physical condition of the building, which was “little suitable and in fact dangerous” for inmates and therefore not surprisingly “a theater for deplorable and unfortunate incidents.”27 He had done his best to make improvements, but it was impossible as long as “the rooms for the patients resemble less a hospital than a cauldron of physical and moral putrefaction” and the personnel was composed of “guardamatti criminali,” that is, convicts from a nearby prison. An Oversight Commission sent from Rome confirmed that Aversa “resembled in no way a [civil] insane asylum either

in its physical structure or in its technical organization” (Tamburini, Ungaro, & Martello, 1910, p. 165). Its architecture did not allow for the separation of different categories of patients or for common spaces and dining areas; it did not provide therapy through work and baths nor laboratories for clinical research. Because convicts were used as guards, “methods of coercion have been too widely adopted” (Tamburini et al., 1910, p. 165). The commission recommended the abandonment of Aversa in favor of building a new criminal insane asylum elsewhere in Italy. Aversa was not abandoned, but Virgilio was hastened into an honorable retirement in 1906 and replaced by his assistant Saporito, who remained the director at the time of Ferri's visit in 1924. Young, energetic, and idealistic, Saporito radically renovated Aversa.28 His dream was to turn criminal insane asylums from “bad prisons” to “general hospitals of criminality” with laboratories for scientific research (Saporito, 1913, pp. 363, 361). Within three years, another oversight commission, led by Tamburini, pronounced a “real satisfaction with a transformation that embodies the good, the useful, and the rational” (Tamburini et al., 1910, p. 166). Inmates were now separated into nine different categories (those in observation, those who were dangerous, those who were calm, etc.); hygiene was improved (gas lighting, hydraulic toilets, new bathtubs and showers); and a hospital diet replaced prison food. Other changes were not as complete. Workshops had been instituted although only about one-third of the inmates were employed. Fewer inmates were subject to physical restraints, although the straight-jacket was still in use. The convict guardamatti had been replaced by prison guards who, while receiving special training for their role, were clearly not professional nurses. Even though Tamburini pointed to the need for additional improvements, he concluded that “this institution will really bring honor to Italy and debunk the common view, also expressed in foreign newspapers, that the Italian judicial insane asylums are built and organized like prisons and therefore represent the negation of science and humanity” (Tamburini et al., 1910, p. 172). Tamburini's pride in the renovation of Aversa led him in 1912 to feature drawings of its floorplans, pictures of its garden, and photos of its inmates in the

27 Virgilio's long and heavily documented letter can be found in ACS, DG Carceri, Atti ammistrativi, b. 373, f 29. Gaspare Virgilio (1836–1908) served as a prison doctor and the director of the civil asylum of Aversa, where the first criminal insane asylum was established in 1876.

28 Filippo Saporito (1870–1955) later became a professor of law at the University of Rome and an Inspector General for the Ministry of Justice. The OPG at Aversa is now named after him.

M. Gibson / International Journal of Law and Psychiatry 37 (2014) 117–126 Table 6 Former professions of inmates in Italian criminal insane asylums (in percentages). Source: ISTAT, 1895, 1904, 1904–1907.

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Table 8 Length of sentence of inmates in criminal insane asylums (in years). Source: ISTAT, 1909–1914.

Year

1895

1904

1905

1906

1907

Year

1–3

3–5

5–10

10–15

15–20

20–24

24+

Agriculture, mining Urban worker Servant Clerk Middle-class Military Vagabonds

55 25 5 b1 11 2 b1

35 25 12 1 5 b1 21

31 27 13 2 1 b1 23

43 30 19 6 1 b1 1

46 33 14 1 3 b1 1

Life sentence

Not sentenced

1909 1910 1911 1912 1913 1914

41 19 24 20 14 13

39 33 33 17 16 13

74 80 64 73 59 51

93 79 91 120 106 115

98 113 130 122 120 117

50 52 82 93 95 87

87 106 97 104 111 126

111 115 109 116 115 114

82 98 104 90 110 102

Note: Numbers are for December 31.

Note: Numbers are for December 31. The last column represents suspects awaiting trial or defendants acquitted on the insanity plea.

psychiatric section of the International Exposition of Social Hygiene, of which he was chair (Tamburini, 1912).

conceived, it nevertheless resembled the treatment employed in civil asylums. The prominent psychiatrists who served as resident doctors and directors were well-trained and eager to turn their institutions into symbols of modernity through empirical investigation of the physical and psychological characteristics of the inmates, the results of which they proudly disseminated in professional journals. While much of the resulting data are of little scientific value today, they are typical of the research carried out in hospitals and prisons throughout the country in this period in order to further the national project of turning psychiatry and criminology into sciences. In short, a more nuanced portrait of the criminal insane asylum, while not meant to excuse their repressive nature or to obscure the absurdities of positivist theory, shows the need for further study of the evolution of each institution, particularly to evaluate whether they fared better after 1904 when put under the direction of medical professionals. Finally, the existence of parliamentary government after unification, with its attendant freedom of speech, was an important factor in limiting the reach, and therefore the repressiveness, of the criminal insane asylum. Despite its many faults, such as the failure to approve a national criminal code until 1889, parliament had the merit of allowing for lively debate between opposing factions. Thus members of the classical school, many of whom were members of parliament, were able to curb Beltrani Scalia's power in 1904 by limiting admission to the criminal insane asylums to indicted and convicted criminals. Criminals acquitted on the grounds of insanity could be interned only in civil asylums and at the discretion of the courts rather than of psychiatrists. Clearly classical jurists were defending their power over the courtroom, but at the same time their writings enshrined a firm belief in individual rights that had its roots in the Enlightenment and had inspired the Risorgimento revolt against autocracy and foreign rule. With the advent of fascism, positivism lost its humanitarian edge and parliament its power. At first glance, the Rocco criminal code of 1930 seems little different from the previous Zanardelli code in its treatment of the insane. According to Article 88, defendants were released from responsibility for their crimes if mental illness deprived them of “the capacity to understand or will” (Codice Penale e leggi complementari, 1991, p. 70). However, while the wording of this article seemed to indicate a triumph for the classical school, it was counterbalanced by a new section on “security measures” applicable to individuals thought to be a threat to social order, even if they had not been convicted of a crime. In the positivist spirit of social defense, judges were given the power to declare defendants, acquitted on the grounds of insanity, to be “socially dangerous” and interned in criminal insane asylums. Listed under the new rubric of “security measures,” this provision was technically not a punishment but instead an “administrative” regulation and thus did not theoretically contradict the definition of legal responsibility. Nevertheless, the fascist introduction of security measures represented a reversion to the situation before 1904, when Beltrani Scalia had opened the criminal insane asylums without

6. Conclusion The few scholars who have previously written about the birth of the criminal insane asylum in Italy characterize it in negative terms, claiming that its major purpose was to expand the power of psychiatrists rather than to treat mental illness (Babini, 1981; Manacorda, 1982; Martucci & Corsa, 2006; Villa, 1980). In many ways, this is an accurate analysis of an institution whose priority was social control over a group of poor and uneducated men who had been admitted under dubious diagnoses. Isolated for long periods from their families and the outside world, inmates were offered little therapy aside from work and baths. Suspects could be held for long periods of observation and, until the Law of 1904, those acquitted on the insanity defense could be interned indefinitely. The use of physical restraint was widespread while education was absent. However, such a wholesale condemnation of the early criminal insane asylum is simplistic and perhaps colored by the more recent memories of their degradation during the fascist and postwar periods. The example of Aversa illustrates that their history was not static but subject to change at the instigation of government inspectors or new administrators. Leading psychiatrists such as Lombroso, Virgilio, Tamburini, and Saporito were honest enough to denounce conditions at Aversa before 1906 and to call for its closure. The appointment of Saporito as director significantly improved the material life of inmates in Aversa, who began to enjoy increased physical comfort and freedom of movement within the institution. In this sense, Aversa began to resemble Montelupo Fiorentino, which had been established twenty years earlier in a large and handsome villa, where inmates lived in smaller dormitories at night and spent their days together in workshops, dining halls, and gardens (Algeri, 1888). While therapy in all three institutions was minimal and ill-

Table 7 Number of letters received and sent by inmate/year. Source: ISTAT, 1904–1914. Year

Received

Sent

1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 1914

4.8 4.9 8.7 7.1 8.9 8.5 9.5 10 9.4 8.5 16.5

4.8 4.9 8.7 7.9 8.2 9.3 9.8 9.9 7.6 8.1 19.2

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parliamentary approval and admitted defendants acquitted as insane. In the Rocco Code, these individuals were to be interned in criminal insane asylums for two to ten years despite the objections of many jurists that judges have no grounds for determining the length of incarceration when there has been no crime (Capelli, 1973, p. 653). As a corollary to its doctrine of social defense, the fascist dictatorship increased the number of criminal insane asylums, opening three more in Naples (1922), Barcellona Pozzo di Gotto (Messina, 1925), and Castiglione delle Stiviere (Mantua, 1939). In 1931, the first criminal section for women was established at Aversa as fascism stretched a web of internment over an ever larger portion of the population (Schettini, 2004). This doubling of the number of criminal insane asylums paralleled a marked expansion in the number of the mentally ill interned in civil asylums, which jumped from 60,000 in 1926 to 96,000 in 1941 (Peloso, 2008, p. 34). Although Italy closed itself off from international developments in psycho-therapy and psychoanalysis during the interwar period, it experimented with new treatments in civil asylums that adhered to its biological tradition. New therapies included the use of drugs and most notably electric shock, which was invented by Ugo Cerletti in 1938 bringing him applause from the fascist regime and international fame. Work remained a central goal of fascist administrators who were urged to turn the carceral institutions into tools for “human reclamation.”29 Despite the fall of fascism, the postwar period saw the retention of the Rocco Code, with its provision for imposing security measures after acquittal on the insanity plea, and the criminal insane asylums, with an additional institution for women opening in Pozzuoli (near Naples) in 1955. By the 1970s, with the expanding political movement for de-institutionalization, the criminal insane asylums also came under scrutiny. According to critics, these institutions were characterized by physical abuse, unhygienic conditions, a shortage of doctors, and the absence of therapy (Manacorda, 1982). Only Castiglione delle Stiviere was staffed by nurses rather than prison guards, but even here, according to one journalist, the patients endured “a violent and bestial life” (Valcarenghi, 1975, p. 171). This same journalist noted that a large portrait of Lombroso hung in the director's office at Montelupo Fiorentina (Valcarenghi, 1975, p. 114). While it is not uncommon to honor founders of an institution, this image of Lombroso also symbolizes the long historical shadow that late nineteenth-century positivist criminology threw on the development of forensic psychiatry in Italy. Many Lombrosian tenets—the biological basis of mental illness, the dangerousness of the insane criminal, and the necessity of criminal insane asylums to protect social order—have had a long life, enduring the change in types of government from parliamentary to fascist to republican. Yet, the perspective of the classical school, while suppressed during the interwar period, has slowly re-asserted itself in new forms, most notably the antiinstitutionalization crusade of Franco Basaglia that resulted in the closing of civil mental hospitals in 1978. It remains to be seen whether the closure of the criminal insane asylums, scheduled for 2013, will signal an equally radical reformulation of the theory and practice of Italian forensic psychiatry.

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29 For an example of fascist propaganda, replete with photographs, about the redemptive power of their prisons, see Grande (1941).

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