Jana Vanecek

The Dark History of Psychiatric Care: Atrocities, Abuse of Power, and Total Institutions in Italy, Switzerland, and the USA

14.03.2023 | Research Blog Genoa | ChatGPT-(GPT4): history of psychiatric care and the atrocities as well as the abuse of power in the asylums in Italy, Switzerland and the USA + the concept of Goffmann’s Total Institution.


The history of psychiatric care is marked by both remarkable advancements and distressing accounts of cruelty, abuse of power, and atrocities. It is crucial to understand this dark history to prevent the recurrence of such inhumane practices and ensure ethical care for individuals suffering from mental health issues. This essay examines the historical context of psychiatric care in Italy, Switzerland, and the United States, with a focus on abuse of power and the concept of Erving Goffman's Total Institution.

Italy: The Age of Asylums

The history of psychiatric care in Italy traces back to medieval times, but it was during the 19th century when asylums proliferated. These facilities were characterized by inadequate living conditions, overcrowding, and the use of extreme physical restraints. In the name of therapy, patients were subjected to inhumane treatments like ice-cold baths, induced vomiting, and bloodletting.

One of the most notorious asylums in Italy was the Ospedale Psichiatrico di Volterra, which operated from 1888 to 1978. Patients were subjected to solitary confinement, physical abuse, and electroconvulsive therapy without anesthesia. The notorious "Basaglia Law" enacted in 1978 aimed to reform mental health care by promoting deinstitutionalization and community-based care, but the consequences of this dark period in Italian psychiatric history continue to reverberate.

Switzerland: Questionable Practices in the Land of Humanitarianism

Switzerland, known for its neutrality and humanitarianism, was not immune to the pitfalls of early psychiatric care. The Burghölzli Clinic in Zurich, which opened in 1870, was a prominent institution for the study and treatment of mental illness. Under the leadership of Eugen Bleuler, the clinic developed pioneering ideas, such as the concept of schizophrenia. However, it was also a place where invasive procedures like insulin coma therapy and lobotomies were performed.

In 1981, the “Sonderbund für Heil- und Pflegeanstalten” (Special Association for Healing and Care Institutions) was founded to ensure the quality of care in psychiatric institutions. Despite these efforts, Switzerland's psychiatric care history remains marred by instances of forced sterilization, electroconvulsive therapy without anesthesia, and physical abuse.

The United States: A History of Asylum Abuses and Reform

The United States has a complex history of psychiatric care, marked by both innovations and appalling abuses. In the 19th century, American asylums began to emerge as a response to the need for specialized care for individuals with mental illnesses. However, many institutions were overcrowded, unsanitary, and patients were subjected to deplorable treatments.

The infamous Willowbrook State School in New York exposed the grim reality of institutional life for individuals with mental disabilities. In the 1960s, investigative journalists and activists uncovered the appalling conditions at Willowbrook, including overcrowding, inadequate care, and rampant physical and sexual abuse. The exposé led to significant reforms, including the deinstitutionalization movement, which aimed to shift mental health care to community-based settings.

Goffman's Total Institution: A Framework for Understanding Asylum Abuses

Erving Goffman's concept of "Total Institution" provides a framework for understanding the mechanisms that led to the widespread abuse of power and atrocities in psychiatric asylums. Goffman defines a total institution as a place where individuals are isolated from society, stripped of their identity, and subjected to strict control and surveillance.

In total institutions like asylums, power dynamics between staff and patients are heavily skewed. This imbalance, combined with the dehumanization of patients, fosters an environment ripe for abuse. Patients are often seen as mere objects to be controlled and manipulated, rather than individuals with rights and dignity. The total institution's emphasis on conformity, compliance, and suppression of individuality can exacerbate mental health issues rather than alleviate them.

In the context of psychiatric asylums, Goffman's theory illuminates how the institutional structure and power dynamics contributed to the widespread mistreatment and abuse of patients. The concept of the total institution also underscores the importance of dismantling such oppressive systems and replacing them with more humane, patient-centered approaches to mental health care.


The history of psychiatric care in Italy, Switzerland, and the United States reveals a dark past, characterized by abuse of power, inhumane treatments, and atrocious living conditions. The concept of Goffman's Total Institution helps to understand the factors that enabled such maltreatment within asylums. Although significant progress has been made in recent decades, it is crucial to remember this history to ensure that individuals with mental health issues receive ethical and compassionate care. By acknowledging the past and continuing to push for reforms, we can work towards a future where mental health care is grounded in empathy, respect, and the promotion of individual dignity.