The research aims to address the human journey and the drama suffered, between 1915 and the years after the Great War, by the soldiers from the southern Italy interned at the Girifalco (CZ) asylum.Through the study of medical records, it is possible to outline the irruption of new mental disorders caused by the life in the trench, as well as to ascertain how the Great War represented an irreparable fracture between the prevalently rural world in southern Italy and the incipient modernization of a society which was at its peak due to technology applied to war and to the 'scientific organization of death'. From this perspective, the study of the distorted mental world of the many southern peasants/soldiers is enriched by new analytical insights enhancing the theme of psychosis and neurosis caused by the war. The act of war, not understood and substantially suffered by the subordinate classes from the south of Italy, turned into an experience of cultural apocalypse in which the disappearance of domestic horizons as well as of the corporeal existence, will leave room for a new experience of alienation and delirium which will lead many fighters to seek refuge elsewhere in a universe covered by a mystical and apotropaic rituality.
The author is part of the Gerda Henkel Foundation-funded research project "Too Much Love. Pathologisation of passions and emotions in Southern Italy during the fascist regime (1922 - 1943)".
Introduction: Historical Reflection on First World War Psychological Trauma
Once psychiatric studies, especially after the Vietnam war, revealed that post traumatic stress disorder was an illness whose causes were directly traceable to the experience of armed conflict, historians began to review from a new perspective the history of nervous disorders of previous conflicts, in particular the First World War. Once freed from the classical categories of military histories, researchers found in the archives of the asylums and psychiatric hospitals a variety of materials – case histories, correspondence with patients’ relatives, reports by local authorities regarding patients and their families – that enabled them to shine new light on the behaviour of thousands of soldiers involved in the war, and verify the impact of the conflict on the patients’ relatives and their communities and, at the same time, to understand the difficulties encountered by psychiatrists, at that time, in identifying the link between war and mental disorder.[1]
The asylum in Girifalco, a small town in the Province of Catanzaro, in Calabria, that housed hundreds of mentally disturbed soldiers during the conflict, is still today a largely unexplored territory. Examination of the clinical documentation has allowed researchers to grasp the effect of the trauma and the devastating impact of modernity that arrived with the First World War on young men from a peasant background and on the archaic rural society of Calabria at that time, as well as to verify the transformation of Girifalco, in the space of a few years, from a remote provincial institution to the second most important psychiatric hospital in southern Italy after the one in Aversa in terms of size.
In Girifalco as elsewhere the war provides a new means of understanding mental illness. After the initial difficulty in identifying shell shock as the cause of mental disturbance, it soon became apparent that the war offered an extraordinary clinical laboratory that enabled doctors and other workers at the institute to discard, slowly and not without difficulty, the classical Lombrosian conception that genetic heredity and family background were the key to understanding every pathological event.[2] Study of the clinical files from the asylum’s archives provides an invaluable insight into the question of madness and the war at a time when the experience of conflict and the soldiers’ fate intersected with the growth of the science of psychiatry. From the documentation it becomes possible to chart the evolution of psychological disorders during the conflict and also ascertain how the doctors began to widen the categories of pathological analysis, transforming a provincial asylum into a modern institute and a “model” in which the study of trauma took on a pivotal role.
The clinical files of the soldiers of the First World War offer original food for thought and also highlight the impact of the intrusion of the grand events of world history on a provincial institution, to the extent of undermining the unquestioned professional assumptions which had hitherto been used to explain and treat psychological disorder, as well as illustrating the actual life of a pre-modern society linked to rites and traditions unknown outside the region. The clinical documentation, in fact, does not merely provide case histories through which one can interpret the anamnestic background of the internees but also, aside the psychological aspects, through study of the files and other sources researchers can trace the outline of a complex social tapestry in which poverty, illiteracy and phobia characterise a society at war.[3]
Girifalco: From Provincial Asylum to “Model Institute”
When in July 1877 the Royal Mental Hospital in Aversa was no longer able, on account of lack of space, to take in “the mad who were a danger to themselves and others” from the provinces of the Calabria Region, it became necessary to establish a new mental asylum in Calabria itself. Hence on 18 September 1878 the Regional Council issued a decree to set up a provincial mental hospital “capable of housing up to 40 or 50 inmates, considering that the province already had 21 lunatics at liberty and not receiving any treatment.”[4] A decision was also taken to locate the new institution in the ancient and abandoned convent formerly belonging to the Reformed Friars, located on the southern edge of the small town of Girifalco. The task of converting the building was given to a doctor from Genoa, Dario Maragliano, who later became the hospital’s first director.[5] Even if the institute was more recent than the other two mental hospitals in southern Italy – the one in Aversa and the one in Palermo – the new complex was embedded in the political framework regarding mental illness of the time, that is to say it was seen as a means of protecting society from the insane. This cultural orientation was later given official confirmation in the 1904 law which authorised the placing of people in an asylum only in cases where “the people concerned were, for whatsoever reason, a danger to themselves or to others, or were liable to cause a public scandal.”[6] This law, in fact, was the logical outcome of a debate on-going in Europe since the middle of the nineteenth century after the publication of a work by Honoré-Antoine Fréiger,[7] which tackled the issue of pauperism and social deviance among the urban and rural working classes, through a ‘scientific’ approach whose aim was to deal with amoral and antisocial behaviours that threatened to destabilise social harmony. This study, which set out to distinguish the working class from the criminal class, was based on the assumption that within the great urban concentrations there were two potentially dangerous categories: the poor and the delinquent.
If it was possible to retrieve the former through a programme of interventions aimed at improving the material conditions, for the latter the solution proposed was that of internment, even for entire groups, in places and institutions that excluded them from the rest of society. The work of Frégier was, indeed, the result of “a process of bourgeois stabilisation launched in various countries […] in which it was possible to discern the influence of the obsessions of a society in rapid transformation, that had to contend with a multiplicity of tensions provoked […] by an unequal process of modernisation and growing social imbalances.”[8] The Italian ruling class at the time was very influenced by this argument and a series of norms to be found in the various codes of the pre-unification states aimed at marginalising those who were considered deviant and socially dangerous. This, in other words, was a common response across European countries that in the process of constructing a national identity considered certain places and groups of people as outsiders vis-à-vis social classes and territories that were to play a central role.[9] Out of this political and cultural mind-set, therefore, the concept of a mental hospital arose in 1904, notwithstanding the doubts and reservations of the Italian psychiatric society who saw in this framework the risk of their role as healers being downgraded to that of minders.[10] In this way the mental hospital became a container to house only those considered socially threatening, thereby transforming the hospital into a place of custodial restraint and excluding all the harmless sufferers of mental illness who were left for their families to cope with, despite their need for medical care. A state of affairs that, in the long run, undermined the psychiatric profession’s ethos based on the principles of health, therapy and rehabilitation in favour of restraint and punishment that reduced the role of the doctor to that of ancillary to the police force.[11]
The story of the Girifalco asylum at the end of the nineteenth century is linked to the name of a doctor from Verona called Silvio Venturi, who from the first of December 1887 held the position of director at the Calabrian hospital. Well known and respected by his colleagues at the time, Venturi was one of the most articulate critics of the new tendencies emanating from the German school of psychiatry; the heated debate among Italian psychiatrists on this issue led to a sort of generational split between the older ‘alienists’ and a young generation of doctors who had qualified in different European countries and were therefore more open to new ideas. The focus of the discussion was the publication of the Psychiatric Compendium by German doctor Emil Kraepelin,[12] which was destined to turn the science of Psychiatry upside down. In this work, which contained clear traces of social Darwinism, it was claimed that a good proportion of mental illnesses were due to the biological make-up of the individual and hence untreatable. Modern psychiatry, therefore, should focus its efforts on those cases of mental instability caused by exogenous factors.
Silio Venturi, on the other hand, believed that the correct approach to the study of pathologies should combine a social and environmental perspective with anatomic investigation of pathologies. This current of thought had a clear identity in Italy at the time, and was one that Venturi defended forcefully in Naples in 1899 on the occasion of the X Congress of the Italian Phrenological Society. During his discourse he stated: “You know that I am no socialist […] and yet I must maintain that it is almost true that, once the three main causes of crime have been removed [food, shelter and sexual needs], humanity becomes peaceful” and he continued to affirm strongly the need for science to consider carefully the causes of social exclusion that could lead to mental illness.[13]
Thanks to this much esteemed physician Girifalco expanded considerably, from a small hospital in a remote province to one of the largest and most important centres in southern Italy. During his tenure laboratories and workshops were built at the asylum for carpentry, typography, a cobbler’s and so on, and, above all, a section was opened for women, and the male ward refurbished to include a separate section with cells for highly disturbed patients. One must not forget that all these ‘improvements’ came at a particularly difficult time because of the lack of resources of the provincial body whose responsibility it was to provide the mental hospital with financial support. Scarcely a year after the director took up his position the provincial delegation expressed serious concerns about the economic management of the hospital which, in the period 1883–1887, had almost doubled its requests for funding from the province.[14] In fact, the expenses required for the running of the Girifalco complex led members of the delegation to consider the dual option of asking the government to transform the hospital into an asylum for the criminally insane run by the state, or in the absence of this, to shut the mental hospital down and transfer its patients elsewhere.
In order to overcome this problem Venturi arranged for many jobs to be undertaken by the patients themselves. Indeed, he is also remembered for being the first psychiatrist to have introduced this kind of work for patients, yet some expressed reservations on the grounds that this unpaid work, which helped the institute to reduce its costs, exploited the patients. Nevertheless, there is no doubt that Venturi’s achievement was to have transformed the role of the Girifalco asylum from a small provincial institute into one whose importance was recognised at national level, by overcoming the initial disadvantages that made it an unattractive place to work for qualified doctors and unappealing to psychiatric associations, also on account of the geographical isolation which made it problematic to maintain fruitful relations with the major centres of research. From the beginning of the twentieth century the Girifalco asylum, along with other institutes, experienced a substantial and progressive increase of patients. This phenomenon, known as “the great internment”, was seen as a consequence of important social and economic changes in Italian society that, at this time, aimed to become a truly modern state under the guidance of an enterprising, albeit ruthless, urban middle class.
As evidence of the interest in the Girifalco asylum, it was around this time that Marco Levi Bianchini first made his appearance on the scene. This young graduate came to Calabria after a brief experience at the psychiatric clinic in Florence and a stay in the Congo in 1901, where he was employed as a medical officer.[15] His time in Africa, which must have been considered quite adventurous by the scientific community of the day, enabled him to publish various articles on infectious diseases and tropical toxicology, as well as two rewarding studies of a psycho-social nature which highlighted his ability to combine traditional psychological work with social issues.[16]
A doctor, whose positivist training made him one of the leading and most fearless exponents of Freud in Italy, he arrived in Girifalco as deputy to the then director, Romano Pellegrini from Verona. Even in this early period he demonstrated great skill and, above all, exceptional scientific knowledge, which soon led him to develop a professional relationship with Sigmund Freud, several of whose works he translated into Italian.[17] This Calabrian period, as with his African experience, helped him to further his scientific work into the boundaries between psychiatry and ethnography. At that time there were many epileptic patients and Levi Bianchini searched for possible links between the internal world of the sufferer and the external one.[18] The religious ritual and popular mythical beliefs to do with possession and witchcraft[19] of Calabrian society in many ways reflected the pathological tendencies of his patients. For this enterprising young doctor any clinical case study always needed to be backed up by a careful analysis of the material and cultural characteristics of the society in which the mental disturbance manifested itself. This meeting with ethnic otherness opened up a new method of observation of traditional ritual, even if his positivist medical background made him little inclined to sympathise with rural society or its rituals. Indeed, he was convinced that the unstoppable progress of modernity would lead to an overcoming and extinction of such forms of superstition and ignorance.[20] Following in the footsteps of Silvio Venturi and his disciple Pellegrini, throughout his Calabrian period, Levi Bianchini theorised and practiced an open door and no restraint policy, the aim of which was to transform the asylum into a self-sufficient rural health colony. He quickly grasped the complexities of Calabrian society and attempted to develop therapeutic techniques in order to “achieve a comprehensive theory and operational guidelines of psychiatric treatment through work.” At Girifalco he coined the term “ergotherapy” for what is known today as occupational therapy […] and it was widely acclaimed by the scientific community.[21] In this vision the work of the ‘resident’ must be progressive, coherent with the pathology and inclinations of the patient and broken up by periods of rest and in no circumstances should the psychiatrist “feel authorised to exploit the labour of his patients.”[22] This final point was somewhat in contrast to the methods of his predecessor Silvio Venturi. Thanks to these innovations, along with considerable structural improvements to the building with the arrival of state funds following the damage caused by the 1908 earthquake, the hospital was recognised by the Minister of the Interior at the time, Giovanni Giolitti, who through the Prefect of Catanzaro Sansone, complemented the administration on their successful and innovative work.[23]The hospital was thus renovated and in the forefront of psychiatric practice. Such was the situation at the time of the outbreak of the First World War.
Perception of Armed Conflict as a Pathogenic Element
In 1979 a famous text by the historian Eric J. Leed tackled the issue of conflict from an entirely new angle compared to the traditional historical works. This insight was destined to reconsider the Great War though the study of the emotions, the imagination and the personality changes of the survivors;[24] an approach which opened the doors to the study of the psychological suffering caused by war trauma in which every day contact with violence, fear and death forced front line soldiers to adopt a different and demystified view of life.
The nervous disorders generated during and following the conflict were a new phenomenon, occurring throughout all the belligerent nations, which gradually involved the science of psychiatry. Historians and social scientists have devoted little attention to the approach the medical profession adopted at the time to this new phenomenon: they have tended to be more interested in understanding the profound cultural and social changes that led to the unravelling of the pre-war equilibrium and try to understand whether any of these alterations contained the seeds that would shortly lead to a mass phenomenon. The paradigm introduced by Eric J. Leed, Antonio Gibelli[25] and Bruna Bianchi,[26] however, appears more effective in detecting all the nuances of the psychological breach brought about by the clash between the combatant and the modern means of destruction of the great conflict, evident in all its terrifying reality even in the early months of the war. The number of pathologies reported by the soldiers clearly shows the unprecedented nature of the phenomenon. Before the mechanical age the mental suffering of a soldier in warfare was expressed in a melancholic form of homesickness, that had more to do with a certain state of mind rather than a neurosis in the true sense; moreover, the fact that in the past armies were generally made up of ‘volunteers’ and professional soldiers certainly placed a limit on the spread of war related mental illness.[27] What occurred during the Great War, with thousands of soldiers interned in asylums in the Italian Kingdom, would appear to be the effect of trauma that is not only a case of mental collapse in the face of the horrors of war, but rather represents an irreparable break with the optimistic vision of an evolving modern society that the belle époque led people to believe was in store for them.[28] The conflict had a devastating effect on the mental world of the poor and “the young peasants who had learned from their fathers to live according to the rhythms of nature, governed by the laws of rural society, […] brutally wrenched from their social and mental universe and suddenly thrown into a landscape in which nothing remained unchanged apart from the clouds, and below those, in a magnetic field of currents and deadly explosions, the minute and fragile body of man.”[29] This is particularly the case in the imagination and for the habits of peasants, and the marginal social classes from the south involved in the conflict, who up until that moment were used to dealing with the hardships of a difficult and rough life in anticipation of a modernisation and progress of which they could only detect a distant echo. They face the impact of the other side of modernisation and come to terms with the “evil wonders” of a terrifying world: they learn the mechanics of the howitzer, the smell of the poison gas, and see its effects on the faces of their suffocated comrades, they endure the trauma of the heavy artillery fire without a break, while they feel encaged in the black hole of the trenches surrounded by an unchanging and devastated landscape of desolation and death.[30]
To the deprived massed, rejects of a civilisation they struggled to understand and were excluded from, the sinister rumblings of the Great War demonstrated all the deadly ambivalence of the much desired modern world. All this signified a rupture in their mental vision and impacted on their way of conceiving life and death. Deprived of the ancient rituals they were familiar with, defenceless in the face of extraordinary events they could neither understand and nor control, they found in madness or in the pretence of madness an escape route, a form of individual rebellion that doctors and psychiatrist had trouble understanding.[31]
The delay with which Italian psychiatry came to grips with the issue of war trauma was the result of a consolidated and stereotypical therapeutic mind-set that sought the origins of alienation and mental illness in biological determinism. An approach born out of the theories of Cesare Lombroso, who saw the aetiology of disturbed or irrational behaviour in terms of atavism, this attitude continued for considerable time to be central to psychiatric discourse in Italy.[32] It is hardly surprising that it was military psychiatrists in close contact with the common soldier who first began to understand that trench neuroses needed to be analysed from a new perspective that swept aside the idea that the patient was ill because of some hereditary malfunction and that sooner or later this pathology was bound to emerge, with or without the experience of warfare.[33] In any case, when the home provinces began to witness the trainloads full of the “alienated”,[34] as the mentally disturbed were referred to at the time, it became clear that the conflict was a highly effective catalyst of pathologies. Psychiatrists began to intuit that the ordeal of warfare could be a laboratory for a new approach to mental illness; from this new perspective it also became clear that the war did not affect only those taking active part, but also those who, far from the frontline, perceived its echo. Such was the case of Tommaso V.,[35] an illiterate man from the province of Crotone, interned on numerous occasions in 1916 in prey to agitation and hallucinations that rendered him a danger to himself and others. In an interview with the hospital director Bernardo Frisco, the distressed patient claimed that his wife had cursed his brother who was at the front causing his death and dishonour but then he was able to bring him back to life. The case of Raffaele C.[36] is a similar one: he was interned in the asylum on 2 April 1916 suffering from severe depression and mental instability. The departure of his only son for the front provoked severe anxiety and confusion, so much so that he abandoned his work and locked himself in his home and refused to talk. Moreover, he had outbursts of anger and repeatedly threatened his wife. Consequently, he was interned in Girifalco on the basis of the law of 1904 where, unaware of his surroundings, he continued to suffer from depression, confusion. From the case files it would appear that he was physically in good health but mentally weak; as he refused to eat he was force-fed. He refused any work and was unwilling to get out of bed even to go to the toilet. There is no record of the treatment adopted, apart from his frequent interviews with the medical staff. What is interesting about this case is the comment of the director, Bernardo Frisco, that attributed the patient’s condition to a hereditary defect, completely ignoring any reference to the war. In the files we also find a reference to a brother of the patient who was also hospitalised in the asylum in Aversa, a factor which seemed to confirm the director’s diagnosis.
Greater care and attention is dedicated to the study of the case of Angelo S.[37] He was interned on 3 July 1916 and allowed home provisionally on 21 August on his father’s request. Considered a reasonable person and a good father,[38] he had never given any sign of instability, nor had anyone in his family had problems with mental illness. When, however, he received the notice that one of his brothers had been wounded in the war, he began to suffer from visual and acoustic hallucinations. He claimed to have been transformed into General Cadorna and he wandered around the surrounding countryside dressed as a soldier in search of his wounded brother. Once hospitalised, he continued to behave in an agitated and confused manner; he was garrulous, irrationally euphoric and his speech was confused. From the care with which file is drafted it is clear that the medical team found this case particularly interesting, because it provided an insight into the way the war could enter into the imagination of non combatants, at times mentally unstable, leading to pathologies. Thus we can see how attention on the effects of war ceased to be confined to frontline soldiers, and consideration began to be given also to the soldiers’ families and the communities they belonged to.
It was Bernardo Frisco, the director himself, who expressed an awareness of the change in 1918 when he said that “if one takes into account the admissions of civilian patients one can observe that […] these too must be studied in relation to the state of war, since all the admissions refer to infirm men and women who had been influenced, directly or indirectly, by the consequences of the war.”[39]
Trench Pathologies and Social Repercussions in Time of War
The effects of the war would soon become the daily bread of the Girifalco medics. From the report drafted to the director of the provincial delegation in 1918 we learn that in the three years since the beginning of the conflict the hospital had been virtually cleared of ordinary patients to make way for veterans from the frontline. In 1916 due to the inability of other hospitals to take in new referrals, a large number of southern Italian soldiers were redirected to Girifalco forcing the administration to reorganise its space and work schedules. Leafing through the reports, year on year, one can note the gradually dawning awareness of the significance of war trauma;[40] nevertheless, there still remained the lurking suspicion that behind the distressed and disorientated behaviour was a desire to fake insanity in order to avoid a return to the front. This prejudice can be seen clearly in the admissions papers on patients’ arrival at the hospital. An example of this is the case of Michelangelo M.,[41] an illiterate mechanic from Calabria first admitted to hospital on 6 May 1916 and diagnosed as suffering from manic depression, frenzy, anxiety and extreme irascibility. Shortly after his admission the doctors described his account of his experience on the lower Isonzo front as confused and uncertain, and were thus unable to form any clear idea of his pathology. A month later, with an alleviation of his symptoms it was considered of little use to keep him in hospital and the soldier was discharged and sent home on probation. Yet the suspicion that the soldier was faking his illness remained. In the documentation attached to the clinical file there is a letter from Frisco to the Carabinieri in the soldier’s town, enquiring whether the soldier has shown any sign of disturbance while at home. The Carabinieri replied that, although his conduct had been good, the soldier was without any doubt mentally ill. Less than two years later the same patient was once again hospitalised at Girifalco with the same diagnosis and once again the doctors cast doubt on the veracity of his mental illness. In the bulging case file, that appears more like the result of a police investigation than a medical account of a course of treatment, there is a touching letter from a sister of the soldier dated February 1918 addressed to the director of the institute in which she asks for news on her brother’s condition, and, to prove that her brother is genuinely unwell she gives an account of his difficult childhood, orphaned when both his parents were burnt to death in a fire at their small dwelling in the countryside.[42]
The most common pathologies found in the clinical files at Girifalco are the diagnosis of mental confusion or melancholy, which today would be termed depression. From these documents it is plain that very little attention is given to a course of treatment and none at all to therapy. In effect, these pathologies were not considered by psychiatrists in Italy as particularly serious or very dangerous, especially in the case of soldiers. At the root of this conviction was the idea that a slight dulling of the psyche was normal if not desirable in a soldier. It is no coincidence that in 1917 Agostino Gemelli, in his description of the mental state of troops in war claimed that the good soldier, especially if he happens to be a peasant, is one who is capable of sublimating his own personality. In other words, loss of self-control and a lowering of the psychological barriers would help a soldier overcome his fear and favour a suitable level of indifference when faced with the horrors of war.[43] This way of thinking was fully supported by the psychiatric community and would have consequences on the therapies which proved to be wholly inadequate in dealing with the veterans’ suffering. The result of all this was dozens of “alienated” veterans, suffering from amnesia,[44] stupor and depression[45] and idiocy,[46] briefly interned in Girifalco without receiving appropriate care and treatment, and then quickly returned to the front line. For these soldiers, without the chance to receive the treatment they badly needed to cope with the trauma suffered in the trenches, or the possibility to come to terms with the devastating alterations in their world view, a psychological disorientation opened up which would accompany them through the successive years of war (and beyond).
Yet soon it became impossible not to realise that the psychological disturbances, neuroses and other forms of mental imbalance were all signs of a problem requiring a new clinical language. In particular, it was cases of shell shock that forced doctors to study the pathology in depth and lead them to a better understanding of the phenomenon. In the investigations into war trauma two aspects came to take on greater importance: the study of the unconscious and the conflicting demands in the mind the individual soldier in terms of his sense of duty and obedience to the dictates of the army. Cases of soldiers traumatised by poison gas, war wounds or the explosion of grenades were, by this time, analysed as real medical illnesses and not as the behaviour of shirkers pretending to be ill, albeit in the absence of full understanding of the phenomenon or possible solutions. Moreover, there was a tendency to categorise everything under the general heading of “moral collapse”, hence there was no need for any specific course of treatment. The role of the medic therefore was to: “reinforce a soldier’s sense of duty and help him regain his self respect”,[47] by boosting the patient’s self-esteem and trying to limit the loss of dignity which was considered unacceptable, and in a sense immoral, for a country at war. It is hardly surprising, therefore, that in the first phase of the conflict it was the task of the doctors in the field hospitals near the frontline to treat the traumatised victims of trench warfare; these medics congratulated themselves on their success at getting the patients back in action, in the belief that such behaviour was merely expression of a lack of enthusiasm for the fight among the weaker elements of the army.[48] However, once the phenomenon reached a certain level it became clear that the army’s neuropsychiatric service was quite incapable of coping with the problem and many soldiers were referred to civilian mental hospitals. Yet the therapeutic methods used in these institutes were not much different from those employed by the army physicians in the field hospitals, that is to say curing the patient by pumping up his virility. In the numerous cases of shell shock at the Girifalco hospital, the only course of treatment adopted seems to have involved “persuasion” and discussions between the patient and the medical staff. A therapeutic approach, in other words, based on the desire to return the patient to the front as quickly as possible, on the one hand, and on a complete lack of real understanding of the problem and how to deal with it, on the other.
A classic example of war trauma is found in the case of Alfonso P.,[49] a bricklayer from Cava dei Tirreni serving in the 48 infantry regiment. On 21 September 1916, he was referred to the Girifalco hospital for observation with the following diagnosis “a syphilitic subject suffering from depression as a result of war trauma”. He was considered fit for release on 27 December 1916. From the case files it appears that he had been sent to the front on two occasions and wounded twice. From the beginning of his stay at the hospital he appeared depressed, confused and prey to terrifying visions. He wore a bandage on his foot to cover a wound contracted at the front. He suffered both from insomnia and from continual nightmares; he feared being alone and constantly asked to stay in company. The therapy adopted followed the usual route: the director and his colleagues had long conversations with the patient, who was also given warm baths in an attempt to alleviate his anxiety, and mercury injections for his syphilis. The desired subject of the conversations with the medical staff was the soldier’s experiences on the front line, but he was confused and unable to give a coherent account of his combat experience. He could, however, remember being wounded, he had severe facial spasms and sometimes burst into tears, symptoms that were aggravated when the prospect of returning to the front was raised, or when he saw his uniform folded on the chair beside his bed.
A similar story is the case of Natale D. A.,[50] a tram driver from Casaminima (BA), who was admitted to Girifalco on 28 July 1916 and discharged on 31 October 1916. The clinical files describe how, while he was on the frontline in Trentino, he was wounded in the auricle of his right ear by a grenade explosion. The patient only realised what had happened while being treated in a military hospital near the front line. After some weeks he was transferred to the military hospital in Catanzaro. Here, after having thrown from his bedroom window a straw mattress and two back packs he picked up a rifle and fired a shot at the Carabinieri barracks next to the hospital. For this episode he was arrested and held in prison, where he was subject to violent convulsions, and subsequently taken to the Girifalco hospital, completely unaware of what had happened. At first the patient suffered from insomnia, hypersensitive hearing, muscular spasms and intermittent bouts of amnesia. From the medical notes one learns that when first admitted any reference to the subject of the war was sufficient to cause a violent alteration in his heart rate and plunge him into a state of depression and feeble mindedness.
The fact of being haunted by war images from which one cannot escape is a common characteristic of many traumatised veterans of the trenches. What does change, however, is the soldiers’ reaction to that sense of crushing defeat that the cries of the wounded, the devastation and the feeling of total impotence in the face of the bloody events on the frontline had generated. Aside from amnesia, stupor, and a retreat into silence, another expression of mental disturbance was the childhood regression of some veterans who lost themselves in a semi-conscious state in which they regressed with even their voices becoming childlike. This is exactly what happened to Vito G.,[51] a bricklayer from the province of Siracusa, who was diagnosed as suffering from “melancholic delirium as a result of trauma and injuries sustained in battle.” Seriously wounded in a grenade explosion on the Carso front, he was taken to a field hospital where – while under treatment – he began to behave in a childlike manner, such as playing children’s games. At the same time, he was haunted by terrifying visions and bouts of delirium during which he would sing musical arias at the top of his voice, even in the middle of the night. As a result, he was referred to the Girifalco hospital in May 1916, where he continued to present the same symptoms. In conversations with the doctors he only remembered episodes from his childhood, which he recounted in great detail, while he made no reference to his war experiences. In order to compel him to talk about these, the medical staff decided to simulate a war scenario by making a series of dull heavy noises resembling a bombardment and to address the patient in the manner of a military superior issuing commands, at which point he became violently agitated.
A similar case is that of an illiterate Calabrian soldier,[52] diagnosed as suffering from dementia, who was taken from the front to the Girifalco hospital. Once again, observing the patient the doctors noted “little somatic development, scare critical capacity and lack of facial hair”. The patient continued to behave in a childish manner, seeming to remember nothing apart from the games played in infancy, which he recounted “in a falsetto voice”. At night, however he was plagued by horrific nightmares, alternating with mystical and religious visions.
Childhood regression is a means of escape into an imaginary world that provides the sufferer with a safe haven from the total chaos of war. The return to childhood becomes the “symbol of a condition of safety and protection and in the regression to a state of childhood the soldier can avoid reality and express his own emotions and weaknesses.”[53]
On other occasions the diagnosis of shell shock was connected to other considerations, in which the border between clinical diagnosis and prejudice was highly suspect. The dramatic tale of Francesco R.[54] is one such case. This soldier was wounded in the arm during the course of a battle on 10 June 1917 and, unable to withdraw with the rest of his comrades, he remained trapped in a trench where, helpless, he endured an intense enemy bombardment. He told the hospital director how he had witnessed the bodies of his comrades tossed into the air and thrown about by the explosions and how he temporarily lost his hearing on account of the noise of the grenades detonating. While he was finding a way to escape from the danger he was thrown to the ground by a detonating grenade and buried under two metres of earth. After being rescued and brought to safety, he manifested extreme excitability, mental confusion and delirium, and was hence confined in a mental institution. The story in itself is enough to explain the origin of the psychosis and the agonised state of mind of this soldier, yet we find, in the case notes, the comments of Frisco who opines that the young man displays evidence of female characteristics in prey to a hysterical crisis, following the trauma of being buried alive. This recourse to the diagnosis of hysteria that located mental illness in the female sphere confirms a preconception commonly held by Italian psychiatrists during the Great War that considered the phenomenon a “constitutional anomaly […] of a personality with psychic malfunctioning.”[55] The cases of male hysteria encountered during the conflict were commonly linked to effeminacy which, especially as regards soldiers, had negative connotations being interpreted as indicative of a lack of character and virility. Also for the Calabrian soldier, there is evidence of the willingness of the medical team to highlight female characteristics, while the terrible trauma of being buried alive is considered of lesser importance. Even when it is recognised that the patient lives “in a pitiful state, wracked by anxiety and fear, and is unable to hide the desire to commit suicide”, all this is still connected with female behaviours without any understanding that “in his bouts of hysteria the soldier affirmed his right to weakness and fragility, […] a form of passive resistance to a war which was experienced passively, with the dominant emotion one of impotence.”[56]
The lack of consideration given to the psychological suffering of those traumatised by their experience in the trenches reverberated in the wider society. In fact, unlike what happened in the case of those who suffered physical injuries, the ‘mentally mutilated’ nearly always had to face the disapproval of a society at war, in which the calls to heroism and sacrifice had become absolute values. The desire to avoid being rejected and stigmatised sometimes had paradoxical outcomes. For instance, the story of Nicola P.,[57] a butcher from Apulia, bears witness to this. This young man of 22 years was so anxious to avoid the shame and dishonour of being considered mentally ill that he claimed he had faked his illness, although he had all the symptoms of war trauma. The refusal to accept his psychological illness by this soldier, who preferred to return to the front rather than be considered mad, fascinated the doctors who gave him particular attention. Nicola’s clinical history begins with a serious head wound received while fighting in the war zone. In 1916 he was first brought to the mental hospital in Udine for treatment, and thence transferred to another in Catanzaro. A document, dated 6 September 1916 and signed by Doctor Captain Riccio, states that while on leave in Apulia, the soldier was in the vicinity of his house when he heard a rifle shot. At this point the patient “went berserk and started behaving violently so that he had to be forcibly restrained and locked in a room for 17 days.” This pathological behaviour was directly traceable to the head wound received while serving at the front. After further treatment in the hospital in Bari, he was again discharged with the following diagnosis, “neurasthenia, suitable for light and sedentary work”. Assigned to his regimental depot he continued to behave in a strange and impulsive manner, and during his convalescence he had little self awareness, was slow to understand things, and excessively aggressive over minor issues. Judged as a danger to himself and others he was referred to the Girifalco hospital, where he underwent careful analysis that led the doctors to conclude that his psychological illness certainly originated with his battlefield head wound and consequent shock. Nevertheless, as soon as Dr Frisco informed the patient that his illness would require a longer stay at the hospital, because his symptoms displayed all the signs of war trauma with transitory bouts of frenzy and convulsions, the soldier reacted violently shouting that “he had behaved in this way to avoid being sent to the front”. He then wrote home and told his father he was the victim of a plot, and his intention was to return to active service as soon as possible. Rather than replying to this letter his father contacted the hospital to ask the director to give his son the best possible care, mentioning that he had already lost a son, who had died some time previously in a mental hospital in Lecce. Attached to the case file is a letter from Bernardo Frisco in response to the patient, after his discharge, dated 9 August 1917, in which he writes: “as you have asked me for an opinion, I believe that in order to preserve your health you should follow the advice of your father. You have need of a period of calm and therefore until your condition has been stabilised for a good length of time, it would not be a good idea to think of marriage because it would certainly put your cure at risk.” The theme of the regeneration of society and eugenics, which are touched upon in this letter, assumed considerable importance in the post-war period, and were widely debated by the psychiatric community. Once aware of the destructive consequences of the war Italian psychiatrists began to reflect on how the new society emerging with the peace settlement could be ‘completely renewed’ in a constructive and biological sense. The war was seen by most Italian eugenicists as the chance to put “on the order of the day the need to ‘regenerate the social body’, as well as to introduce practical and verifiable medical procedures of the ascertainment and selection of a eugenic programme.”[58] The need for ‘social defence’, as stated in the law of 1904 on the setting up of asylums, would become the subject of heated debate the aim of which was to regulate marriages and control couples who intended to procreate.[59] This is another indication of the devastating impact of the Great War on a disorientated society, forced to change its way of thinking and come to terms with the dark side of modernity, in which human life itself had lost every value.
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