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THE HISTORY of the SALENTO's MENTAL HOSPITAL and the USE of SOMATIC THERAPIES Introduction Only from the XIX Century

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THE HISTORY of the SALENTO's MENTAL HOSPITAL and the USE of SOMATIC THERAPIES Introduction Only from the XIX Century Acta Medica Mediterranea, 2017, 33: 1051 THE HISTORY OF THE SALENTO’S MENTAL HOSPITAL AND THE USE OF SOMATIC THERAPIES MARIA ROSA MONTINARI,* SERGIO MINELLI** *Department of Biological and Environmental Science and Technology, University of Salento, Lecce, Italy - **ASL Lecce, D.S.S. n. 52, Lecce, Italy ABSTRACT In this article, we are going to retrace the history of the Salento’s Mental Hospital, one of the largest psychiatric facilities in Southern Italy and we whilst addressing the use of somatic therapies in this institution. The Provincial Mental Hospital of Terra d’Otranto, established since 1897, started operation in1901, under the direction of Dr. Giovanni Libertini. In 1931, after the advent of fascism, with the split of the Lecce Province into three provinces (Lecce, Brindisi and Taranto), The Mental Hospital turned into a hospital consortium, called The Interprovincial Psychiatric Hospital of Salento (OPIS) and subsequently, from 1985 to 1998, The Psychiatric Hospital “Giovanni Libertini”. At The Interprovincial Psychiatric Hospital of Salento (O.P.I.S.) somatic therapies, and in particular Electroconvulsive Therapy (ECT), were widely used. Afterwards, in the 1950s, with the advent of psychotropic drugs (neuroleptics, antidepressants, MAO inhibitors tricyclics, benzodiazepines), the success of somatic therapies and in particular of ECT decreased significantly. The recent renewed interest in somatic therapies - again considered in the most advanced scientific studies and used in a large number of renowned hospitals and universities - is linked to the considerable deepening of the biological knowledge of such thera- pies and to drug resistance of many psychiatric illnesses. Therefore, we considered it opportune to historically analyze the use of somatic therapies in one of the most important psychia- tric institutions of Southern Italy. Keywords: Salento’s mental hospital, history, somatic therapies, Electroconvulsive Therapy (ECT). DOI: 10.19193/0393-6384_2017_6_166 Received December 30, 2016; Accepted June 20, 2017 Introduction The problem of assistance and care of the mentally ill did not exist. Only from the XIX century - after the The main concern of society was to keep sepa- demonological conception of mental disorders - rate, segregated and excluded, those who for vari- psychiatric illnesses were considered morbid forms ous reasons could be dangerous, cause harm to oth- in the strict sense. Before then, an ethical-religious ers, or were unable to provide for their mainte- model was widely spread that saw psychiatric ill- nance. nesses as expressions of magic, divine or demonic Then the madness was often confused with influences; so the mentally ill were reputed pos- other economic, social or health conditions which sessed individuals that had to be exorcised. These made some people unable to live adequately in civil people represented a threat, a social danger that was society. necessary to isolate from the rest of society, even at With the medicalized reading of mental health the cost of segregation, the use of violent methods, problems, structures dedicated to the care of psy- and the suspension of all rights. chiatric patients began to spread. 1052 Maria Rosa Montinari, Sergio Minelli In most cases, the mental hospitals were countryside and villages and often belonged to poor derived from pre-existent structures (hospitals, hos- families, who could not bear the burden of their pices, convents), but in some cases the buildings care. In addition, there wasn’t an adequate structure were built ex novo: the reference model was the where the insane were kept even only temporarily, Panopticon, designed by the English philosopher- waiting to find an asylum to house them elsewhere. jurist Jeremy Bentham in 1791. In July 1879, the Public Administration began In Italy - in keeping with the social mandate of searching for a suitable building, which was identi- the law of 1904 - the asylum was mainly a contain- fied in the workhouse of Lecce, (State Archives of er in which to hide and check the waste of society. Lecce, Sheet 120, Envelope 26) located in the ex- Curative purposes were secondary to the main pur- Convent of The Olivetans, suppressed - like the pose of social control. other convents - by the law dated 7 July 1866. The Obviously, even the history of the Salento's temporary admission of the “poor idiots” was orga- Mental Hospital reflected the political - health nized into four “custody rooms”, adequately pro- choices of time. vided with padded walls and restraint beds (ibi- The birth of the Provincial Lunatic Asylum of dem). Terra d' Otranto in Lecce, its transformation into The medical director, Giuseppe Vigneri, guar- Interprovincial Psychiatric Hospital of Salento anteed that those rooms were fit to contain furious before and then in the Psychiatric Hospital fools and structured in such a way that the insane “Giovanni Libertini” are, in fact, a sign of the evo- could not harm themselves or others. However, the lution of Psychiatric Institutions(1). alienated could stop in the custody rooms for up to In this article, we retrace the history of the ten days, then having to be sent to a real mental Salento’s Mental Hospital and we particularly want hospital, in particular to the Aversa’s Mental to study the use of somatic therapies in this institu- Hospital (Institute since 1813), to which the tion, treatments widely used in psychiatry until the Provincial Deputation of Lecce paid onerous hospi- 1950s and then abandoned because they are consid- tal fees, with the right to check, at any time, that ered obsolete and outdated. This interest is derived adequate treatment was offered to the patients from the finding that, in recent years, somatic thera- (State Archives of Lecce, Sheet 151, Envelope 34). pies in psychiatry are again considered in the most Doctor Vigneri was the first to have the idea of advanced scientific studies and are used in a large setting up a mental hospital in Lecce: he was cer- number of renowned hospitals and universities. tainly discouraged by the difficulties in which he The currently most used and interesting was forced to operate, disheartened by the paucity somatic therapies include, in addition to of the means and overburdened by the growing Electroconvulsive Therapy (ECT) note: Magnetic demand for admission by the population. This idea Seizure Therapy (MST), Transcranial Magnetic was later acquired by the provincial administrators. Stimulation (TMS), deep Transcranial Magnetic In Lecce there was another convent available, Stimulation (deep TMS), Transcranial Direct that of the Friars Alcantarini which - according to Current Stimulation (tDCS), Vagus Nerve the above-mentioned law of 7 July 1866 - had been Stimulation (VNS). surrendered to the Provincial Administration. The Also at the Interprovincial Psychiatric Alcantarini’s Convent - originally defined as the Hospital of Salento (O.P.I.S.), one of the largest Convent of St. James as it is adjacent to the psychiatric facilities in southern Italy, somatic ther- homonymous church - was a building built by apies, and in particular ECT, were widely used. Ferrante of Aragon in the second half of the fif- teenth century. In 1614 it was then donated by History of Salento’s mental hospital Philip III of Spain to the Alcantarini, a Franciscan congregation of Spanish origin, who had dedicated The Provincial Lunatic Asylum of Terra the complex to St. Pasquale. d’Otranto, 1897-1930(1,2,3,4). (Manicomio The official transfer of the convent at Lecce Provinciale di Terra d’Otranto, 1897-1930) Province took place on 23 September 1870, with At the end of the nineteenth century, there was the obligation to use it as an asylum of beggary. an urgent need to establish a provincial mental hos- Instead, in contravention of this clause, from March pital even in the land of Otranto. At that time, the 1871 until August 1881, some premises were tem- many mentally ill were probably scattered in the porarily granted in use at the Practical School of The history of Salento’s mental hospital and the use of somatic therapies 1053 Agriculture. Finally, in 1887 and for 10 years, the In later years (from 1903 to 1930) the hospital structure was utilized as a barrack hosting the 84th - after the initial adaptations of the ex-convent of Infantry Regiment. San Pasquale - was enlarged, further renovated with Only ten years later, with a return note of 29 other pavilions, other services and other beds. In July 1897, it was finally returned to the Province. particular, the construction of the laundry room and Meanwhile, on 3 January 1895, in a historic ses- workshop, the 2nd Women and Men's Pavilion, the sion, the Provincial Council of Terra d’Otranto Medicine, the showroom and the warehouse build- unanimously voted to institute a mental hospital in ings was realized. Consequently, in addition to the Province of Lecce and on 1 December 1897 the patients, also the staff responsible for their care Provincial Deputation presented to the council an increased. articulated project, with cost estimates, for the adaptation of the buildings of the ex-convent St. The Interprovincial Psychiatric Hospital of Pasquale, drawn up by the engineer Luigi Libertini. Salento, 1931-1985 The Libertini engineer took advantage of the spe- (Ospedale Psichiatrico Interprovinciale cialist counseling of the psychiatrist Giovanni Salentino, O.P.I.S., 1931-1985) Libertini, who in turn went to Naples and Florence after: to request clarification to his famous masters The Psychiatric Hospital “Giovanni Professors Bianchi (State Archives of Lecce, Sheet Libertini”, 1985-1998(1,2,3,4,5) 147, Envelope 33) e Tanzi. (Presidio Ospedaliero Psichiatrico "Giovanni In 1900, the works of completion of the hospi- Libertini”, 1985-1998) tal could be considered concluded: in the ex-con- In 1931, after the advent of fascism, with the vent the alienated found a rational placement, split of the Lecce Province into three provinces divided according to their typology.
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