A diagnosis you can't refuse Psychologists reveal depths of trauma among mafiosi

Leonardo Vitale made his way into the Sicilian mafia at age 19 by killing a boss from a rival clan.

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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 grants that have highlighted the psychiatric impacts experienced by current and former mafia members, their relatives, and their victims.