Carlo Livi: a modern doctor in the study of mental illness and in the doctor-patient relationship

Two hundred years after his birth, the authors remember the figure and thought of Carlo Livi, one of the most representative exponents of the new psychiatric culture of the second half of the 19^th century. In doing so, they highlight Livi’s ideals of great humanity, which accompanied his extensive professional expertise throughout his life. Indeed, charity and commitment to the underprivileged classes became his precise moral and social duty, the very essence of his being a doctor, which found its highest expression in his relationship with the patients of the two large mental hospitals that he directed: San Niccolò Hospital in Siena, from 1858 to 1873, and San Lazzaro Hospital in Reggio Emilia, from 1874 to 1877. In Siena, he considered his project to renovate the city’s mental hospital to be a civil mission, whereby he could exploit his scientific knowledge in order to improve the inhumane living conditions of the mentally ill poor. To this end, in addition to restructuring the hospital building according to the most innovative criteria, he deemed two concepts to be fundamental to the assistance and treatment of mental illnesses: moral care and occupational therapy. Moral care, which Livi preferred to physical treatments, was aimed, above all, at resolving the patient’s symptoms, and was based on knowledge of the patient’s history, of the initial signs of madness, and of its contributing causes, including the influence of the social environment. The centrality of the patient as a person was also evident in Livi’s use of occupational therapy, which had an extremely important socialization value, being capable of restoring patients’ dignity, of which society had deprived them. In an era in which the causes of mental illnesses remained largely obscure, Livi tried to forge a relationship with his patients through dialogue; by taking an interest in their past experiences, he strove to define a future project aimed at reacquiring, partially or totally, their mental abilities and their role in society.