Baron Pietro Pisani and the Moral Treatment of the Mentally Ill

Perhaps this story interests me because my maternal ancestors came from Palermo, Sicily. It was there in 1824 that Real Casa dei Matti (the Royal Home for the Insane) was founded, by Baron Pietro Pisani. Unlike similar institutions in Europe and the US, Pisani was dedicated to the ‘moral treatment’ of his patients and rejected the use of chains and beatings.

Pisani was born around 1760. He had a fondness for the finer things in life, mainly painting and music, but he put his aristocracy and social advantage to a beneficent cause.

In 1802, Pisani was outraged by the living conditions of those suffering from tuberculosis, leprosy and severe mental illness. They were locked up  together and forgotten about after confinement in the Ospedale di S. Giovanni dei Lebbrosi. Sooner or later, patients with mental illness were transferred to the institutional building of the ex-noviziato dei Padri Teresiani ai Porrazzi which Baron Pisani began managing in 1824, transforming it into Real Casa dei Matti.

He promoted therapies that involved recreational activities and entertainments, even pioneering an early form of occupational therapy. He was very open to ideas spearheaded by popular physicians specializing in mental illness. Patients were not locked in cells when at all possible; a walk in the gardens and participation in growing  food crops (which would then be used in the institution’s kitchens) was encouraged.

Also considered important was hygiene and clothing as well as pride in one’s appearance. Pisani believed daily structure was beneficial, thus avoiding unexpected intrusions which could lead to rampages. Music was used as a therapy, foreshadowing the ‘Mozart Effect’ by several years (in addition to being a calming influence, its benefits are associated with helping to quell anxiety, hypertension, and epilepsy). Poetry was also read to groups of confined patients, the verse and cadence chosen to mentally soothe and stimulate thinking in a lucid manner.

Pisani’s method classified patients rather than lumping them all in one chaotic category. His classifications would sound quite provincial today, (eg. maniac), it is interesting to note he had a special category ‘malinconici’ (melancholy), or in today’s terminology, depression.

Pisani considered allowing visits from relatives when the living in society began to gradually became a possibility for some patients after they were sufficiently improved. Because of this, he believed it important that they sustain contact with people and events beyond the institution. It would also a prepare the patient for a future life in society.

News of Pisani’s efforts began to spread beyond Casa Real. In 1835 an article was reproduced in “The Friend”, a US magazine, which quoted a US surgeon’s visit to Casa Real. The cutting-edge administration was witnessed and reported thusly:

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 US surgeon also noted that carefully documented archival records were kept and that the institution had an abundance of staff who had to follow 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 extreme cases, chiefly to protect the patients from harming themselves. While Casa Real could not be thought of as a walk in the park by any stretch of the imagination, Pisani was light years ahead of most similar institutions.

Alexander Dumas refered to Pisani in the 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.”

Edgar Allan Poe was inspired by Pisani in “The Metropolitan Magazine”. He wrote the satirical story: ‘The System of Doctor Tarr and Professor Fether’. The fictional French insane asylum he writes about, used to have a ‘soothing’ regime which was then replaced by a stricter and cruel game plan implemented by the fictitious Tarr and Fether, a reference to medieval punishments. Poe likely intended his story to be a satire on the prevailing barbaric practices found in many American institutions.

Pisani’s ideas have been implemented through the ages, though was never talked about either in nursing school or any psychiatric facilities I worked in, nor had anyone remembered hearing of him!

© 2022 Guiomar Goransson