Leonardo Vitale made his way into the Sicilian mafia at age 19 by killing a boss from a rival clan. He continued his violent career as a mafioso for the next 12 years until his arrest in 1972 and transfer to a maximum-security prison when, after a week of isolation, he began to self-harm and show signs of depression.
Overwhelmed by remorse for the criminal acts he had committed, Vitale suffered a nervous breakdown. The former boss felt “guilty” and “impure” to the point that, upon his release from prison a year later, he voluntarily went to the police station in Palermo to confess to two murders. He also provided the names of dozens of other bosses involved in criminal activities. Diagnosed with diminished capacity and schizophrenia by doctors, he was placed in a psychiatric hospital. When he was released, the mafia had already condemned him to death. Vitale was killed with two gunshots to the head on 2 December 1984.
The case of Vitale was the first of its kind studied by Prof Girolamo Lo Verso, a psychotherapist and writer who more than two decades ago started offering a course at the University of Palermo on the psychology of the mafia, in the heart of a city where the shadow of Cosa Nostra – the Sicilian criminal organisation – once loomed large. It today boasts dozens of students and research findings that have highlighted the psychiatric impacts experienced by current and former mafia members, their relatives, and their victims.
“The mafia is not just a criminal organisation,” Lo Verso said, adding that on entering members renounce their sense of self and begin a psychological process to insulate them against remorse. “The new affiliate is taught that the only rules that matter are those of the clan. Everything else, including the rules of the state, counts for nothing […] Becoming part of Cosa Nostra is like entering a cult in which members must leave behind their own identity,” he said. “As long as they remain part of the mafia, they do not experience remorse or regret. They do not feel pain or sorrow, even when it comes to killing.”
He said the goal of the university course, the first in Italy, was “to delve deeper into these themes, to research the damage the mafia does to the mind, in order to understand it better.”
Everything changes, Lo Verso said, when something disrupts the mobsters’ lives. “As long as they are integrated into the mafia family, the bosses do not show any kind of psychological suffering,” he said. “Their own ‘self’ is suppressed because they identify totally with the mafia and their thoughts conform to those of the clan. However, things change when there is a break, a detachment from the mafia, for example, when an arrested mafioso decides to collaborate with the authorities.
“It is then that the mafioso, like Vitale for example, is forced to face their own ‘self’ and the problems that arise after having spent a life as a criminal. The former mobster has a real identity crisis. He perceives himself as weak, devoid of values.”
Those who are turned to testify against the mob, the so-called pentiti, are the ones who suffer the most among the mafiosi: transferred to secret locations in northern Italy and cut off from their former lives, psychologists who have worked with them described them as among the most devastated individuals they have encountered. Alone, rejected and branded by their former clans as traitors, many are dependent on medication.
“During my research, I had the opportunity to meet a Sicilian mafia hitman from the Marchese clan,” Lo Verso said. “He lived in a secret location, in a tiny village far away from Sicily. He suffered from depression and insomnia. He had killed more than 100 people, and 50 of them he had strangled. He had enormous hands. Nevertheless, when he told me that his only companion was a dog, I felt pity for him.’’
But the impacts of mafia violence on mental health are felt most keenly by victims and the relatives of the victims: the mothers, brothers and sisters who have lost husbands, children and fathers to the brutality of the mob.
“These people remain stuck in those tragedies and struggle to move on with their lives,” said Cecilia Giordano, an associate professor of psychology at the University of Palermo. “I met a woman whose son and husband had been killed by the mafia. She suffered from dissociative disorders. Their traumas affect future generations, and the saddest thing is that the Italian state does not provide any psychological support for these people who are in dire need of it.”
Psychiatrists and psychologists have also noticed that an increasing number of the family of mobsters suffer from mental illness. When in the 1980s and 1990s the Italian state began to dismantle the clans and prosecute their members, their children especially started to experience profound existential crises. Their fathers were no longer perceived, as according to mafia lore, as men of honour, but as heartless criminals forced to flee from the police or imprisoned for decades without any possibility of seeing them.
“In the mid-1990s, we noticed that dozens of patients with mental issues, who were children, wives or relatives of mafia bosses, began arriving at Sicilian hospitals,” Giordano said. “They showed symptoms of identity problems and personality disorders. Many of them were very young, and their fathers were either fugitives or in prison. We’ve also noticed that the phenomenon of mafia psychology is highly influenced by the role of the mother. If the mother also comes from a mafia family, it will be very difficult for the son of a boss to escape the trap of the mafia mentality.”
Of the bosses themselves, as long as they remain part of their clan, Lo Verso and Giordano cannot imagine them seeking the help of a therapist. The actions of fictional mafia bosses such as Tony Soprano of TV’s The Sopranos, played by James Gandolfini, who went to his analyst to treat his depression and panic attacks, or Paul Vitti, played by Robert De Niro in the movie Analyze This, who relied on the care of therapist Billy Crystal, belong only to Hollywood’s imagination, they suggest.
“They do not need it. Bosses, as long as they remain in command or play a role within the organisation, even if in prison, do not suffer from any mental problems,” Lo Verso said. Their lives, the psychologists say, are marked by pure psychopathology, specifically delusions of omnipotence and a lack of trust towards others.
Bosses who have claimed mental illnesses, including entering courtrooms in straitjackets, have frequently been found to be feigning their claimed conditions in order to obtain acquittals or release from prison. Totò Riina and Bernardo Provenzano, two top bosses of the Sicilian mafia who underwent psychiatric evaluations, spent their last days in prison.
The Palermo research is also looking at the impact of the mafia on society as a whole. “There are places in Sicily, even today, where discussing the mafia is done cautiously, speaking in a low voice” says Giordano. “Omertà is one of the many psychological consequences the mafia has on society. Understanding these aspects of Cosa Nostra can help us recognise it and, consequently, why not, fight against it.”