The birth of the insane asylum, the place where mental illness was isolated from society, can be attributed, according to Michel Foucault, to the practice of the mass committal of wandering outcasts (the unemployed, beggars, invalids, syphilitics, epileptics and degenerates) to the Hospital Gιnιrale, founded in Paris in 1655. The incarceration of these people was Europe’s answer to the 17th-century economic crisis and resulted in a clean sweep of the streets, freeing them of the "annoying" and noisy mob of fringe communities. One in one hundred Parisians spent at least some time in the General Hospital, a practice observed in many European regions at the time. These institutions also sheltered the "crazies", whom, in the 17th century, the curious public could view through the railings on a Sunday morning outing for a penny. In England alone, where statistics are available, the spectators amounted to more than 100,000 people annually . When the economic crisis was over, the poor found moral restitution through the industrial society since there was a need for a workforce. In the 19th century, the emerging science of psychiatry introduced isolation treatment, segregating the mentally ill in special asylums. Though while the asylum was considered the inviolable place of protection and care, in the insane asylums, physical and mental violence were the norm at the outset of all methods of treatment.
In Ottoman Greece, churches and monasteries were the places where mental illness was treated or where, in the latter case, the afflicted withdrew years on end. Many churches, in fact, had a cell in the chapel where the mentally ill resided chained to a large ring on the wall.
These patients, forever fettered, participated in mass, which supposedly play a therapeutic role in their treatment. The seven metal rings attached to the icon screen of the Church of Agios Antonios in the center of Thessaloniki is one of the few still existing tangible testimonies to this practice. The first insane asylum in Greece was founded in 1838 by the British Administration on the island of Corfu while there was no State-run psychiatric facility until the First World War. In the late 19th century, the Athens Police was still arresting the mentally ill, whom they locked up in basement cells. From 1914 to 1915, a group of such prisoners and other fringe characters were transferred from an Athens police station to a deserted villa in the suburb of Kallithea. In the ‘20s, the inmates numbered approximately 3000 and were living in squalid conditions, without medical attention and under police surveillance. The chaotic cross between hovel, prison and asylum gave birth to the Athens State Mental Hospital. The mental hospitals in the cities of Thessaloniki and Souda had very much the same beginnings.
The history of the Leros Psychiatric Hospital starts with the history of the buildings where it was housed. The Italians, who ruled the island from 1912 to 1943, built a naval station in the interwar years in Lakki, the largest natural harbor of the Eastern Mediterranean. It was a ‘New City’, designed on the model of Littoria, Sabaudia, Pontinia, Aprilia and Pomezia, which were designed according to the policy of a "return to the earth", a plan that the fascist regime promoted as a levee to protect urban centers from the huge influx of migrants. The barracks that appeared in this picturesque Aegean settlement, hosting approximately 7000 soldiers, were austere and modernist in architectural style. In 1943, Leros fell into the hands of the Nazis and then, after a short-lived stint under British rule, it ceded to free Greece in 1948. Lakki’s unique buildings, from both the architectural but also from a city planning point of view, had long been dismissed as a remnant of fascism. In 1949, however, part of the deserted Italian barracks became the home to the Royal Technical Schools, centers for training, educating and "reforming" young rebels and orphans of the Greek Civil War, providing shelter for approximately 16,000 children from 1949 to 1964. Towards the late 50s, when these schools had practically emptied, Members of Greek Parliament from this province applied pressure for the creation of a mental asylum in Leros since there was a need to lighten the load of other asylums in the country, which, following the Civil War, were immensely overcrowded with three or four patients to a bed. The MPs maintained that the island was becoming deserted due to migration and that they had the ready solution of the old Italian barracks. This suggestion came on the heels of a Swiss consultant’s proposal for creating rural colonies of mental patients, following the example of German and Swiss asylums in operation since the 19th century. Therefore, in 1958, the "Leros Colony of the Mentally Afflicted" was founded in the towns of Lakki and Lepida.
"Colonists" subsequently started being transferred by ship in small groups and in 1965, in larger groups of 250-400 patients, each wearing a number on their clothes. Some of these numbers were lost during the transfer, resulting in a group of approximately 20 patients becoming "anonymous", despite attempts to identify them. After the loss of self in the asylum, these patients’ last link to their social identity was also tragically lost. The conveyance of these patients by ship is reminiscent of Alsatian poet Sebastian Brant’s 1494 poem Ship of Fools (Narrenschiff), which inspired the painting of the same name by
Hieronymus Bosch circa 1500. In medieval Europe after all, and especially in Germany, it wasn’t unheard of to cram the "crazies" on ships, and unburden them in faraway places. In the "Colony", which became a Psychiatric Hospital in 1965, approximately 4500 mentally ill and mentally handicapped patients were hospitalized, most coming from the two biggest asylums in the country: Dafni in Athens and Lebeti in Thessaloniki. The criteria for the selection of the patients to be shipped off to Leros was how incurable they were deemed to be and whether they had received visitors in the last one or two years. The approval, of course, of the psychiatrists of the era was also required. These patients were the "unwanted".
Ever since antiquity, the Greek isles had been used as place of exile for those ostracized from society, due to the natural isolation the islands offered. Despite that in the interwar years the Aegean had become a new symbol of aesthetic and intellectual ideals, the luminescent cradle of Hellenism, and despite that after the Second World War the groundwork for mass tourism had been laid, the practice of exiling the mentally ill continued until relatively recently. Apart from housing the orphans from the Civil War and the mental patients, Leros had also served as a place of exile during the Greek seven-year dictatorship, known as the Junta of the Colonels, from 1967 to 1974, with approximately 4000 political exiles in two camps, one in Lakki and one in Partheni (1967-71). The Lakki camp was housed in the buildings of the Royal Technical Schools, where the exiles and mental patients lived in adjacent wards, divided only by a barbwire fence. In fact, the political prisoners were often threatened that they would end up "on the other side". The asylum’s Ward 16 was later housed in a building of the political exiles’ camp. The dizzying succession of the fascist army, the centre for "national education", an insane asylum and then a prison, all housed in the same facilities on the island, justify Foucault, who saw that all bodies of authority sprang from the same root and expelled the "miasmas" of the society of each era, aiming at an "ethically pure" society. This succession was also crucially instrumental in bringing about the development of a local "institution-based economy". It is interesting to note that those islanders who had stakes in the supplies for the political exiles camp were quick to protest when the dictatorship granted the prisoners amnesty in 1971 for fear of losing their income. After all, 800 of the island’s 6500 some inhabitants worked either directly or indirectly for the asylum, which hospitalized an average of 2000 patients.
The patients of the asylum’s sixteen wards lived like animals, which in some cases, due to the institutional inhumanity, no longer resembled the human race. Many patients had ceased speaking; they ate in utterly squalid conditions where the smell of the food was mixed in with the stench of urine and feces; many patients were naked and/or chained to their beds. There were only one or two doctors attending more than 2000 patients. Daily life in these human stables had degenerated into institutionalized lethargy. Suicide was a common occurrence. Mortality rates, in fact, in the Leros Psychiatric Hospital were 60 times above that of the general population. Indicative of the conditions is that, in the 1980s, the asylum’s children’s ward was excluded from an EU psychiatric reform program due to the high proportion of invalid children. The nightmarish Ward 16, known as the "Ward of the Naked", was established in 1984 so that the most wretched patients could hide from the visit of an international group of doctors. Most of this ward’s patients had injuries and disabilities, lived in filthy buildings, were hosed down by the attending staff and were often subjected to physical abuse. The staff, mostly made up by local fishermen and farmers, had not been trained in any way. Operating as animal tamers in the day-to-day jungle of the asylum, they also slowly started slipping into institutionalization, often finding relief in tranquilizers. Thus, the asylum that was supposed to have saved the community from poverty eventually led it to spiritual decline.
In the other institutions, of course, things were not so rosy either: in Athens’ Dafni Asylum in the 1960s, the patients wallowed in their own excrement and there was one doctor on call per 2500 patients. The "Colony" somewhat improved on the doctor/patient ratio in comparison to other psychiatric hospitals, but the institutional practices did not change. Greece’s psychiatric hospitals were not able to overcome the confusion out of which they were born during the interwar years as prisons of souls. The delay of the advent of psychiatry to Greece was added to the low standard of living, which hindered the care of needy social groups, to the horror of the two World Wars, the exiles, the Nazi atrocities, the Civil War, and deeply rooted conservatism. The mentally ill and other fringe groups were often stigmatized or considered a counter-productive burden and were thrown into the abyss of the asylum, into a journey of no return.
At the end of the 1970s, a team of doctors called the Leros Group (made up of Drs. Skliri, Georgiadis, Ioannidis, Loukas, Bairaktaris, Moroyannis and Tolias) alerted the world to the appalling situation in Leros. In a 1981 article in the Greek newspaper Ta Nea, the group called for the cancellation of the scheduled transfer of patients from Athens and Thessaloniki to Leros, denouncing the "crudeness and zero therapeutic effect of an asylum where the patients were like the living-dead and were either permanently restrained or medically sedated." Despite this serious accusation, this article was printed in one column on the last page of the newspaper. This group of doctors viewed the psychiatric hospitals as institutions of abuse that had to be closed down while at the same time it considered psychiatry a social battle and saw the practice of committal as the strong-arm of an autocratic social mechanism. Their voices, however, managed to pierce the wall of indifference and turned the eyes of some towards Leros. In the spring of 1982, reporter Kostas Papapetrou and photographer Nikos Panayotopoulos visited Leros for a reportage for Tahydromos magazine. There was a wind of change blowing due to the recent victory of the socialist party, which favored revealing scandals of the long office of the preceding conservative party. Thus, permission to enter the institution, as impossible in the past as it would be in the future, became achievable at the critical moment of hands-changing in the political relay race, something that knocked down hurdles, though sometimes only temporarily. Yiorgos Depollas followed the mission as a freelance photographer. Unable to choose which places they could visit, the team received a guided tour for a few hours through only two of the wards, obviously prepped for the occasion.
What was Depollas’s approach to the Leros Psychiatric Hospital? While in most of his projects he tries to have as much control as possible over the image, both technically and artistically, perhaps due to his studies in cinematography, where even the simplest shot is the result of meticulous organization, the time limitations in Leros, along with the shock at the spectacle, led him to an instinctive handling of the camera, where raw reality was exposed without much rhetoric. This can be seen in a series of choices that decisively defined the framework of the project. It is clear, for instance, that the emphasis in the photos is placed on the human condition. The documentation of the institution’s premises, both interior and exterior, is sketchy and supplementary. The photos are often taken at close range, enabling a head-on approach to the subject. Yet the photographer does not creep stealthily; he openly makes his presence felt and invites the potential participation of the patient, a stance that oftentimes leads to a silent, yet essential, exchange. He is respectful of those who refuse to communicate, such as the patient who hides his head in his blanket or the people blindly gesticulating and vacantly staring into nothingness. Living in the harsh conditions of the asylum, after all, often leads to a retreat into a mysterious inner world: it is the last act of resistance in the face of a barbaric dead-end, a resort from which it is not certain whether one can return without losses. In other photos, Depollas captures a sense of collectiveness, as small groups of patients develop companionship as a defense mechanism. Indicatively, in a photo of a group of men, almost all naked, they sit on the cement pavement of the courtyard in bow-like formation. They seem absorbed in other worlds, crumbling like living ruins, mutely absorbing energy from the existence of the other. The photograph depicts co-existence in a place full of broken souls and locked bodies that often conceal hints of smiles.
A good number of photographs are portraits, taken, with exceptions dictated by the particulars of the patient and the space, at the eye-level of the subject. In this way, these photos offer the committed patient the position of the fellow-conversationalist, choosing to confront him not as an exotic creature to be photographically tamed, but with the sincere acceptance and the same probing gaze that Depollas seeks in his other projects – a genuine existential vibe. After all, respect for madness, according to Foucault, can be manifested only when it is recognized as the outer limit of human truth. Many of the gazes in the portraits come from deep within, from the innermost depths of the self, in some cases exorcizing the extreme conditions with calm retrospection, like in the picture of the man crossing his fingers while scrawled slogans dance on the wall behind him. In another close-up photo, beyond the head of a young man, the shadows of branches create a chaotic crisscross of lines that meet and divert, outlining a vague patch of confusion. Some of the patients are of indeterminate sex since their social and biological roles have been violently annulled.
One group of photographs makes use of the power of the snapshot as a direct documentation of the asylum’s conditions, drawing the relation between humans and space while respecting human dignity beyond photogenic impressions that feed the gaze, but hinder comprehension. One example is the photograph in the courtyard of one wing where a small crowd of patients aimlessly wanders in disorderly, lonesome circles, plowing the open space. It is a long-range shot, the human forms punctuating the landscape. Some sit pensively on forgotten benches, others loll on the ground while still others numbly plod or chat in twos, swallowing this wafer of freedom that the institution probably offers to shield from cannibalism. In other instances, the photograph is an accusation, portraying the naked bodies, the shaved heads, huddled together, like bundles of laundry, the deterioration of the human condition into savagery, as with the naked woman chained to a tree or the dark gaze of the young man swathed in blankets. Depollas was dumbstruck at the sight of this chaos where gravely physically ill patients, who did not receive any particular medical attention, were lopped together with the mentally retarded and with others who found themselves institutionalized due to "aberrant" behavior and were not able to negotiate their release from the asylum. These were people who, after being locked away for so long and abandoned by their families and society, had nothing left but the asylum.
The nakedness of the "unwanted" reveals how exposed they were, both literally and figuratively, impelled towards atavistic reflexes for which they were continually punished, surviving by accident only due to their own personal resources of resistance. In a society that consciously or unconsciously insists upon the shame of the naked body in the sense of the original sin, the patients’ nakedness is proof of the shift of the "unwanted" to the ultimately "unseen". This nakedness is strangely contradictory to the preparations for the inspection of the visitors: the gleaming floors, the swept courtyards, the whitewashed garden walls and trees in a display of whiteness that belies a superficial – if not ironic – attention to cleanliness. Depollas’s photographs suggest the asylum as an unmasked and uninhibited microcosm where tenderness is succeeded by raw violence. This is betrayed in the photo of the woman squeezing a doll to her chest in a large, deserted ward that retains the coldness of the old army barracks. In the same ward, in another photo, two women dance with their arms wrapped around each other, in an attempt to exorcize the demons of madness, loneliness and oppression. Around them, the beds are laid and lined up in an imposing, if not unnatural, demonstration of absolute order to which the doll remains the sole observer.
The children with the melancholic eyes, without the slightest vestige of a carefree childhood, did not have the opportunity to get to know the world that sent them there: some were committed as early as the age of seven. The large sawn tree-logs on the grounds seem to be a sharp reminder of their amputated lives. In one picture, a man sits aloft one of these logs, his back to the lens in the empty courtyard. The vague loneliness of his presence converses with two foot-trodden paths in the grass that stop at the wire fence: there’s no escape except into the depths of one’s own self. People slip in to the shadows of walls, plunged into silent monologues that bounce off the glossy oil-painted walls. Some gazes are blurred by the dizzying cocktail of madness, meds and madhouse violence, while others exude a light in an alternation between resignation and a thirst for life. The austere buildings, their limits delineated by the barbwire fences, as well as the interior spaces, sealed off by columns and bars, clearly bear testimony to the conditions of imprisonment. In the same way, the rectangular frame of the photograph dangerously echoes this architectural austerity, operating as a limiting frame in the perception of the world of the asylum. The interiors are reminiscent of medieval dungeons and seem stripped of any traces of civilization. In a democratic society where the slogan of material affluence is systematically spouted and imposed, the bareness of the buildings seems to painfully contend with the nakedness of the asylum’s interned, who are cut off from any contact with individual or collective memory, from the sense of time or participation, unable to hold onto anything reminiscent of their previous lives. Foucault, once again, points out the confusion between the hand that punishes and the hand that heals. The photographs of patients of the Leros Psychiatric Hospital show them to be people who possess no defenses in the face of the lens. They do not seek to primp their image if, that is, they possess any self-image at all. The person and his or her image seem to meet uniquely on the flat surface of the photo, practically annihilating the distance between existence and the anxiety of representing it. This can be seen in the young girl sitting in the twilight zone between light and shadow, who sends out a calm deep gaze brimming with questions. The black and white film, Depollas’s preferred medium, underlines the frugality and austerity of subject, allowing no sidestepping into seductive splashes of color.
Concentrating on pure photography also expresses the desire to ward off gratuitous artistry or stylistic antics. The photographs unavoidably contain a contradictory handling of time. The split second required to create them in the limited time available during a visit from the "real" frenetic world goes against the static waters of asylum time, which is occasionally and irregularly rippled by the arrival of new patients or the death of old ones. Depollas and Panayotopoulos were not the only ones to turn their lenses to the entrails of asylums at the time. In 1982, director Kostis Zois shot the prize-winning documentary about Leros entitled The Unwanted. On the international scene, there was Milos Forman’s One Flew Over the Cuckoo’s Nest, which presented the psychiatric hospital as a place for imprisonment for any anyone who was different, ranging from the psychologically depressed to the petty criminal, thus attempting to delve into the dark world of psychiatric arbitrariness. Even earlier, in the late ‘70s, Raymond Depardon’s photography project San Clemente about the mental hospital near Venice created a sensation. Depardon’s work, mainly based on the power of the snapshot, depicts the fleeting images of the mental condition and teems with symbolism: shadows transform the patient into a ghost-like form, while the contrast of light and shade is a clear innuendo. Before that, in the wild times of the 1960s, when photographers pit themselves against the establishment, they wandered through the dark alleys of society and found their way into maximum-security prisons. There was a vigilance and a belief in the power of social change and the photographers assumed their positions for battle. But the voice of the asylum was not so easily heard since it comes from so deep within.
The debate concerning the reform of the psychiatric hospital started in Europe and America after WWII when the moral dimension of health issues had by this time become pressing. One reason for this was the deaths due to starvation during the war: approximately 40,000 patients in European asylums had died of starvation. Another reason the status of the asylums was now coming under scrutiny was the absolute horror of the concentration camps along with the heinous medical experiments carried out by the Nazis, which included the euthanasia for the mentally ill. From 1965 to 1975, criticism of asylums took the form of an anti-psychiatry movement that doubted the operation and the reasons for the existence of psychiatric hospitals. Franco Basaglia, a pioneer of Anti-institutionalization in Italy, accused the psychiatric hospital as being a countertherapeutic institution and a tool of social exclusion, and psychiatry as a device of the dominant system, which uses the mantle of science to limit divergent behavior and preserve the social order and homogeneity needed for unobstructed conditions for production. The asylum came to the fore not only as a medical issue but also as a political one, since despite the supposed "liberating the insane from their chains" by Philippe Pinel in Paris in the early 19th century, the fetters that bound the mind and body of the interned patients were still very strong, fortifying involuntary committal to a mental institution and making it nothing more than a prison for the mentally ill.
The accusations concerning Leros in 1981 managed to put a stop to the transfer of patients there, while Panayotopoulos’s bleak photographs in Tahydromos magazine’s special report in 1982 were a punch in the gut. It’s worth noting that eight out of the nine pages of the expose contained only photos, something unprecedented in Greek journalism at the time, dramatically allowing the images to rule over words. It was then that an attempt to reform the institution began, something, however, that the State did not have the necessary maturity to support in essence. The nightmarish Ward 16, in fact, which a few years later was to take on dimensions of an international scandal, was founded as recently as 1984. It is striking that the psychiatric community did not react collectively, despite the countless accusations and the Tahydromos report. It is thought that the psychiatric community was more or less aware of the situation, but preferred to go along with it and tolerate the State’s indifference and, ultimately, its irresponsibility. It has been reported in fact, that in other mental institutions, the more "bothersome" patients were threatened with being sent off to Leros. Yet, Leros was not the exception. It was simply publicized more broadly and filled the frame so that the horrific conditions of other mental institutions did not receive so much attention.
In early 1989, a group of employees at the Rehabilitation Unit of the Thessaloniki Psychiatric Hospital and a similar group of employees at the State Psychiatric Hospital in Leros, on the initiative of Yannis Loukas and Kostas Bairaktaris, along with a large number of volunteer students from the University of Thessaloniki, started an intervention in Ward 16, challenging on the institutional model. A corresponding intervention started at the same time on the initiative of Thodoros Megaloeconomou in Ward 11. Later, as part of a European collaboration, an Italian and Dutch team joined this group. In September 1989, while these interventions were being put into effect, the Observer newspaper published an exclusive article entitled "Europe’s Guilty Secret" about the mentally ill, mentally handicapped and invalids interned in Leros, living in conditions that foreign correspondent John Merritt described as being reminiscent of a concentration camp. It was followed by a BBC documentary on the same topic. This triggered an uproar in the international press, making the island known as the dumping ground of Greek psychiatric hospitals, and Leros went down as one of the blackest pages in the international annals of psychiatry. The repercussions in Greece were also considerable: we had now become utterly exposed in the eyes of civilized
Europe, which, of course, had its own guilty secrets. The headline in the Greek daily Eleftherotypia, for instance, ran "The Ridicule of the World!" It discovered the "modern gates to Hades|" only through the British press’s harsh descriptions, even though the situation had been documented years earlier in the Greek press.
Once again, this situation revealed contemporary Greek reality: we founded asylums and "colonies" based on the norms and laws of Europe, which was the beacon of contemporary civilization. Then came the scolding from the "teachers", due to overzealousness in applying these rules, and the shame of the exposed "pupils". As Thanasis Karavatos notes, both the doubt and the reform were, naturally, coming from the West. The European outcry concerning Leros contains the pharisaic surprise of those who found themselves before their own barbaric and not so distant past. It was only in 1977 that the World Psychiatric Association adopted principles such as informed consent ("No procedure shall be performed nor treatment given against or independent of a patient’s own will.") and abuse of position ("The psychiatrist must on no account utilize the tools of his profession, once the absence of psychiatric illness has been established.") And it was as recent as 1989 that the first declaration for the rights of the mentally ill was made.
The years of hard work carried out collectively by the above-mentioned teams considerably improved the lives of the Leros patients, many of whom gradually started living again as humans with human desires. A rural co-op was established along with workshops, where many of the patients learned to make handicrafts. They started to venture beyond the confines of the hospital and later some became outpatients. Today, most of the patients live in small groups in hospices supervised by specially trained nurses. The patients were able to claim their equal rights as citizens for the first time. Contrary to the past, the locals played a significant role in the social reintegration of the patients.
The systematic work, however, that took place on Leros does not reflect what has been happening in general in psychiatric reform over the last twenty years. Though the lives of the patients have been significantly improved, changes have been fragmented, lacking in scope, often resembling technocratic strategy rather than the overturning of asylum mentality. Some psychiatric hospitals were downsized or closed altogether without remedying the problem; some hospices for former patients were discovered to be locking the patients out at night or tying them to the beds, disregarding, in effect, the worldwide success of psychiatric policy. This policy, among other things, made provisions for keeping the patient connected to the social and family environment, provided a complete network of services at all levels aiming at avoiding the development of chronic conditions and institutionalization, and it recognized the rights of the patients. The result of the weaknesses of the reforms was the phenomenon known as "the revolving door" effect, that is, the involuntary return of patients to the psychiatric hospital for treatment and "neoinstitutionalization" in many hospices. It is indicative that the first Declaration of the Panhellenic Committee of Individuals with Psychiatric Experience continues, in the year 2008, to demand the right to informed treatment while denouncing psychiatric violence and sedation, mechanical and chemical immobilization, the "quiet roomsfor therapeutic isolation", the unchecked administering of psychoactive drugs and involuntary committal based on court orders In the same strain, the results of the research conducted by the Hellenic Psychiatric Association are striking: In the year 2007, out of the 10,000 people committed to psychiatric institutions in Greece, approximately half had not given their permission.
Photography played a significant role as a means of alerting the world to the situation and as a lever for social change in the Leros situation. The relation between photography and asylums has gone through various historical phases. In the 19th century, it was used as a means to witness, recognize and diagnose the situation. Hugh Welch Diamond was one of the first to photograph female patients at the Surrey County Asylum using calotypes (paper coated with silver iodide) in 1850. Diamond’s illustrated Physiognomy of Insanity attempted to develop the theory of physiognomy in mental conditions. But while there were asylums equipped with photography studios in the 19th century, these were later removed for reasons of patient confidentiality. Photographing the inmates did not only require the cooperation but also the permission of the administration and the attending doctor. Thus, the State could involuntarily commit someone to an institution for life, where violence and suppression burgeoned under a veil of secrecy. A commonly known example is of the post-Stalin Soviet Union, where dissenters vanished into mental asylums and were labeled as mentally ill. In 1966, in fact, the Soviet psychiatrist Andrei Sneiyevsky announced a form of "slow developing schizophrenia" with "practically undetectable symptoms." The World Psychiatric Association realized that this was a mere pretext for imprisoning people for political reasons in the name of a hypothetical illness. Various allegations had been made, but the WPA did not act on them for fear of exacerbating Cold War tension. Thus, politics had put the medical science into its pocket at the highest of echelons.
The isolation also fostered what is called "the second illness", the social stigma of mental illness, following the examples of syphilis, tuberculosis and cancer. This cultivated the often delusive image of the violent, incurable patient, justifying the absolute controlling authority of the doctor. The interned patients on the whole remained "unseen" although they had the right to decide whether they wanted to be photographed, be it in the context of the psychiatric hospital or not. It is true that some of mentally ill do not have a clear perception of the practice and the applications of photography and cannot control their image. Yet when one aims at revealing institutional violence, he or she cannot expect to be able to do so with the blessing of the person who fosters this violence. The photographer has the crucial responsibility of documenting the inarticulate cries of those fading away without crossing the line into exploitation of the subjects. The question can, nonetheless, be looked at from the reverse side: how many "normal" citizens are unsuspectingly photographed, unaware that they will be displayed in art albums and exhibitions, newspapers and magazines? How many know or are given the opportunity to check the context in which their image is created and publicized?
The matter is clearly broader and demands the creation of a set of rules that protects the rights of representation and protects against the abuse of representation or publicizing the photographic image. This set of rules needs to equally serve the rich and the poor, the ill and healthy, the city and country dweller, citizens of the First and Third World, putting an end to the distinctions that often make photographic (and any other type of) representations or refusal to be represented as a class or racial issue, which is linked, as Susan Sontag astutely notes, to the retention of power or the entertainment of the masses.
But can madness be depicted? In the 1880s, the British polymath Francis Galton sought for the face of madness by superimposing many brief exposures of the faces of madmen on the same negative, thus creating a "composite" portrait. Ultimately, what is it that something like the Leros project portrays? People who resist institutionalization? The horrors of the asylum environment? The mental illness itself? Undoubtedly, it can give glimpses of all of these and perhaps even more. In the asylum, however, photographers may easily resort to depicting fleeting images of what they think they understand, what they have been trained to recognize, since the lack of familiarity with mental illness may often hold them hostage to the stereotype. After all, one could make the analogy between the asylum and war: it is a forbidden zone with social conventions that have been decisively ruptured; it is a place to unload the victims of the social war that still fiercely rages unabated. Inflamed by harsh and extreme conditions, the photographer can easily become the predator hunting for the alien, exclusive version of a reality that satisfies the viewer’s voyeurism from a safe distance. According to Panayotopoulos, "Photography always considered the margins of society a tasty dish with different or exotic ingredients to be discovered by people as soon as they emerge from the routine of their own reality." The image of "divergent" reality can, of course, be molded in a biased way according to the terms of "normality", without clarifying the relation between photography and reality or defining what divergence actually means.
Depollas tries to remain outside the realm of sensationalism, avoiding the historically given perception of the "madman as spectacle" and "madman as animal". He walks the tightrope between the accusations against the Leros Psychiatric Hospital and viewing the inmates as people being punished for their illness. He considers Leros as the most definitive moment in his career as far as awakening him to his social responsibility as a photographer. His stance is reminiscent of Diane Arbus’s work in the 1960s. Arbus’s rich harvest of New York fringe communities included disarming photos of transvestites, dwarfs, neurotics, and all kinds of strange characters, responding to Edward Steichen’s grand but simplistic exhibition entitled The Family of Man that lyrical humanism is not enough. For humankind to become united, both the visible and invisible social boundaries must be crossed. We have to look the other side straight in the face.
Can such a work ever transcend the dramatic social conditions that gave birth to it and be elevated to the status of a work of art or will it ever remain a mere artistic documentation to a greater or lesser degree? The answer, which perhaps loses its meaning when one is faced with the profound darkness of the asylum, is that the essential austerity with which Depollas approaches the Leros Psychiatric Hospital establishes the photograph as a social documentation, a historical record and artistic expression, where awakened consciousness and deepseated will for self-expression go hand in hand. This austerity, which drastically condenses artistic thought and act into vital form, is, after all, one of the greatest artistic virtues.
Another question also springs to mind: how could the accumulation of so much knowledge have led to tortuous incarceration and abandonment, products of criminal negligence that were protected by strong doses of selfishness, ignorance and racism? In his Yard With Lunatics
(1794), Goya portrays naked or rag-clad madmen wearing fake crowns. The only difference with the images of Leros, despite spectacular leaps in science and sociology, is that there are no crowns. So where did medicine go wrong?
Thodoros Megaloeconomou attempts to explain this seeming contradiction by saying that, "classical psychiatry, with its therapeutic aspirations – and at the same time at war with them – offered itself up to serve governmental mechanisms that arose from urban revolutions in Europe." Psychiatrist Dr. Thomas Szasz similarly stresses that psychiatry attempts to protect the integrity of an extremely heterogenic and pluralistic society and its dominant morality. Both positions clearly assign to psychiatry – at least as it is applied in psychiatric hospitals – a predominantly non-medical role.
Depollas’s photographs of Leros were little publicized and after years of delay as he was concerned about cheap sensationalism and political exploitation. In any case, he was aware of the legal inconsistencies, which – much more in the past than today – made photographers unable to defend the integrity of their images and, hence, of their positions. The denunciation of the Leros situation was served through Nikos Panayotopoulos’s photographs, which, with the exception of the few photos in the Taxydromos exposed, also remain largely unknown. The publication of Depollas’s project twenty-five years later is not, nonetheless, untimely nor is it a mere historical testimony. A part of the psychiatric community claims that the slate of the institutional model has not, even today, been wiped clean and that much still needs to be done to ensure the dignified living conditions of the patients, true integration and the removal of the social stigma associated with mental illness. In addition, at a time of acute social problems when the reasons for social alienation abound (refuges, immigrants, the unemployed and drug addicts), the work that raises public awareness and arms the militant conscience is crucial, even if the circumstances that brought them about are waning. Without disregarding the illness itself, the photographs of Leros ask us to face the abuse of the mentally ill in institutions head on. This is the abuse that Franco Basaglia called "crimes in times of peace". The photographs ask us to ponder on the fact that there cannot be a Leros without the collective responsibility for expelling the culprit, the "threatening" Other. There cannot be a Leros in a society of citizens that negates the regulative myth of "normality", in a society that recognizes and protects difference. As photographs, they bring us face to face with the bottom of the barrel, the degradation and debasement of human existence cloaked in the veil of authority and science. They also reveal the inability of photography to describe the chilling experience as a whole (how can one add the senses of smell and sound? How can one fit into the photo frame that which the mind refuses to perceive?). And so these images are a crude, fragmented documentation of the fragile human soul and ultimate human cruelty. At the same time, they preserve the memory of a widespread institutional practice; they are a legacy left to those who will show greater resistance in the future; they disseminate more knowledge about goings-on that remained consciously locked behind closed doors and high walls.
This is the direction towards which the recent exhibition and publication entitled The Lives They Left Behind: Suitcases from a State Hospital Attic points. It focuses on the Willard Psychiatric Center in New York’s Finger Lakes district. In the 126 years of its operation since its foundation in 1869, this psychiatric facility hosted more than 50,000 patients, half of whom lived out their days there. When the institution closed in 1995, a few hundred suitcases were discovered in the attic of an abandoned building: they were the suitcases of the patients who had arrived there not knowing that they would never leave again. The exhibition presents photographs of the patients, their suitcases and their personal items, allowing the viewer to mentally piece together the fragments of these people’s lives before theydisappeared for good behind the institutional walls. They provide insight to microcosms that have been permanently invaded.
During the course of another such attempt to negotiate the conditions of the mental hospital through photography, Depardon was characterized as "transparent" by Basaglia due to the ease with which he acclimatized to the asylum. Depollas, on the other hand, consciously remained visible, endeavoring to represent those who remained "unseen" in their illness, in their imprisonment and in their utter abandonment as human beings. The difference between the two photographers’ approaches seems small. In reality, it is a large, daring step to pass through "the modern gates to Hades" with your eyes open.
 Foucault, Michel. The History of Madness (unabridged), ed. Jean Khalfa, trans. Jonathan Murphy and Jean Khalfa, (London: Routledge, 2006), pp. 44, 49, 53-54, 56, 85-86, 224-228 (all cited pp. from the Greek edition, Iridanos Publications).
 Dimitris N. Ploumbidis, Istoria tis psychiatrikis stin Ellada [The history of psychiatry in Greece] (Thessaloniki: Sinhrona themata / Triapsis Logos, 1989), pp. 23-27, 119, 125-130, 220, 223.
 ∞. ∫. Antoniadis, "Agnoimenos diethnismos: I architektoniki tou Lakkiou, Anthropos ke Horos" [Ignored Internationalism: The Architecture of Lakki, Man and Space], CORPUS, No. 20 (1983), pp. 27-38, in M. Beloyanni-Argyropoulou, "Lakki Lerou: Mia ‘diaforetiki’ elliniki poli" [Lakki, Leros: A ‘Different’ Greek Town], CORPUS, No. 37, (April 2002), pp. 74, 77-81.
 Kostas Papapetrou (text), N. Panayotopoulos (photos), "Therapeftirio Lerou, Imegali mas dropi" [Leros Psychiatric Hospital: Our Great Disgrace], Taxydromos magazine, No. 16 (22 April, 1982), p. 36
 Lina Yannarou, Kathimerini newspaper (March 3, 2007).
 Ta Nea newspaper (Dec. 16, 1981) p. 12.
 M. Foucault, The History of Madness, p. 96
 M. Foucault, The History of Madness, p.70
 Franco Basaglia, "Rehabilitation and Social Control", Kinonia & Psihiki Igeia, No. 2 (January 2007), p. 34
 K. Papapetrou et al "Therapeftirio Lerou" [Leros Psychiatric Hospital], Tahydromos magazine, pp. 28-36.
 Ioannis Loukas, "Leros ke psihiatriki metarrithmisi: apo ton idrimatismo ston neo-idrimatismo" [Leros and psychiatric reform: from institutionalization to neo-institutionalization], Kinonia & Psihiki Igeia, No. 3 (May 2007), p.32. 12. Christos Mihailidis, "Diethnos rezili!" [International disgrace!], Eleftherotypia newspaper, (11 September, 1989), p. 22
 Thanasis Karavatos, "I politiki tis psihikis igeias sti hora mas: provlimatismoi ke prooptikes" [The policy on mental health in our country: speculations and perspectives] in A. Douzeni, L. Lykouras (eds) Psihiatrodikastiki (Athens: Pashalidis, 2007).
 Thanasis Karavatos, "I politiki tis psihikis igeias sti hora mas: provlimatismoi ke prooptikes" [The policy on mental health in our country: speculations and perspectives] in A. Douzeni, L. Lykouras (eds) Psihiatrodikastiki (Athens: Pashalidis, 2007).
 Thanasis Karavatos, Ithika ke deontologika zitimata stin psihiatriki [Moral and ethical issues in psychiatry], under publication.
 This declaration was made during the congress entitled The Words of the Excluded, which was organized in June 2008 by the Aristotelian University of Thessaloniki.
 Yiorgos Kiousis, "Souls in the Storeroom", Eleftherotypia newspaper, June 23, 2008, pp. 20-21.
 The theory of physiognomy claimed that a person’s character is reflected in the facial features. Modern physiognomy was primarily promoted by Swiss pastor Johann Kaspar Lavater in the last quarter of the 19th century. In keeping with this theory, there were attempts to categorize mental illnesses based on the facial features of the patients.
 Pierre Morel, Jean-Pierre Bourgeron, Elisabeth Roudinesco, Au dela du Conscient. Histoire Illustree dela psychiatrie et la psychanalyse [Beyond the subconscious: the illustrated history of psychiatry and psychoanalysis], (Paris: Editions Hazan – Hachette Livres, 2000), pp. 197-198 (pp. cited from the Greek translation, Athens: Exantas publications).
 Susan Sontag, "On Photography", trans. in Fotografos [Photographer], Athens: 1993, p. 166
 Martin Kemp & Marina Wallace, Spectacular Bodies: The Art and Science of the Human Body from Leonardo to Now (London: University of California Press – Hayward Gallery, 2000), pp. 134-135.
 Nikos Panayotopoulos, "Leros, ikones psihasthenias / psihasthenies tis ikonas" [Leros: Images of mental illness / the mental illness of images] in Psihiatriki ke ikona / Ikones tis psihiatrikis, Hellenic Photography Selections, No. 3 (April-June, 1991).
 Thomas Szasz, The Manufacture of Madness: A Comparative Study of the Inquisition and the Mental Health Movement (New York: Harper and Row, 1970) p. 81 (pp. cited from the Greek edition Thessaloniki: Ianos, 1983).
- Depardon, Raymond, San Clemente, Centre Nationale de la Photographie, Paris 1984.
- Foucault, Michel, The History of Madness (unabridged), ed. Jean Khalfa, trans. Jonathan Murphy and Jean Khalfa, London: Routledge, 2006.
(Greek edition, Iridanos Publications).
- Frizot, Michel (ed), "Body of Evidence" by Michel Frizot, in A New History of Photography, Cologne: Konneman, 1998.
- Kemp, Martin & Marina Wallace, Spectacular Bodies, The Art and - Science of the Human Body from Leonardo to Now, London:
University of California Press – Hayward Gallery, 2000.
- Morel, Pierre, Jean-Pierre Bourgeron, Elisabeth Roudinesco, Au dela du Conscient. Histoire Illustree dela psychiatrie et la psychanalyse
[Beyond the subconscious: the illustrated history of psychiatry and psychoanalysis], Paris: Editions Hazan – Hachette Livres, 2000
(pp. cited from the Greek translation, Athens: Exantas publications).
- Ploumbidis, Dimitris N., T. Karavatos, Y. N. Christodoulou, "I vasikes grammes exelixis tis psihiatrikis & I anaptixi tis psihiatrikis stin Ellada mehri to 1950"
[The main lines of development in psychiatry & the evolution of psychiatry in Greece until 1950] in Anthologio psihiatrikon keimenon
[Anthology of psychiatric texts], Athens: Greek Psychiatric Society, Vita, 2006.
- Ploumbidis, Dimitris N., Istoria tis psychiatrikis stin Ellada [The history of psychiatry in Greece] Thessaloniki: Sinhrona themata / Triapsis Logos, 1989.
- Rosenblum, Naomi, A World History of Photography, New York: Abbeville, 1989.
- Szasz, Thomas, The Manufacture of Madness: A Comparative Study of the Inquisition and the Mental Health Movement, New York:
Harper and Row, 1970. (Greek edition Thessaloniki: Ianos, 1983).
- Baillon, Guy, "Positive and negative lessons from French policy in the sector (1960-2006)", Synapsis (Overview of Psychiatry,
Neurosciences and Humanities), No. 4, Winter 06-07.
- Basaglia, Franco, "Rehabilitation and Social Control", Kinonia & Psihiki Igeia, No. 2, January 2007.
- Basaglia, Franco, "Social Structure, Health and Mental Health", paper delivered in 1979, Kinonia ke Psihiki Igeia, No. 3, May 2007,
to be published in the book Enallaktiki Psyhiatriki [Alternative Psychiatry] by Kastaniotis Publications.
- Beloyanni-Argyropoulou, Mary, "Lakki Lerou: Mia ‘diaforetiki’ elliniki poli" [Lakki, Leros: A ‘Different’ Greek Town], CORPUS, No. 37, April 2002.
- Karavatos, Thanasis, H. Andreou, "The stigma of the illness", Archives of Hellenic Medicine, 21(3), 2004.
- Karavatos, Thanasis, Ithika ke deontologika zitimata stin psihiatriki [Moral and ethical issues in psychiatry], under publication.
- Karavatos, Thanasis, "Five Basic Positions on Psychiatric Reform", paper delivered at the panel discussion The Policy of Mental Health in Our Country:
Speculations and Perspectives, on the occasion of the 50-year anniversary congress of the Hellenic Center for Mental Illness, Athens 15 Dec. 2006.
- Karavatos, Thanasis, "From the Asylum to the Psychiatric Hospital and Psychiatric Reform", paper delivered at the panel discussion on "Psychiatric Reform"
at the 19th Panhellenic Psychiatric Congress, Athens: 4-8 May 2006.
- Loukas, Ioannis, "Leros ke psihiatriki metarrithmisi: apo ton idrimatismo ston neo-idrimatismo" [Leros and psychiatric reform:
from institutionalization to neo-institutionalization], Kinonia & Psihiki Igeia, No. 3, May 2007, p. 32.
- Papaioannou, Hercules, "Epitirisi ke apagorefsi" [Surveillance and Restriction], Fotografos, No. 109, Nov. 2002.
- Papaioannou, Hercules, "Ta portreta tou Yiorgou Depolla" [Portraits by Yiorgos Depollas], Fotografos, No. 99, Dec. 2001.
- Papapetrou, Kostas (text), Nikos Panayotopoulos (photos), "Therapeftirio Lerou, Imegali mas dropi" [Leros Psychiatric Hospital: Our Great Disgrace],
Tahydromos magazine, No. 16 (1458) 22 April, 1982, pp. 28-36.
- Psihiatriki ke ikona / Ikones tis psihiatrikis, Hellenic Photography Selections, No. 3 April-June, 1991.
- "Yiorgos Depollas: People in the Psychiatric Hospital", interview with Yiorgos Depollas by Natassa Markidou, Fotografia, No. 2, 2nd period, July-Aug, 1989.
- Casalotti, Elizabetta, "O efialtis tou apoklismou paramenei" [The nightmare of exclusion remains], Eleftherotypia, May 5, 2007.
- Fyntanidou, Elena, "I psihiatriki metarrithmisi hreiazetai epiegontos... psihiatro" [Psychiatric reform is in urgent need of... a psychiatrist], To Vima, April 18, 1999.
- Kiousis, Yiorgos, "Psihes sto balaouro" [Souls in the Storeroom], Eleftherotypia newspaper, June 23, 2008.
- Merritt, John, "Europe’s Guilty Secret", Observer, Sept. 10, 1989.
- Mihailidis, Christos, "Diethnos rezili!" [International disgrace!], Eleftherotypia newspaper, Sept. 11, 1989.
- "Pentaplasioi oi akousioi engleismoi stin Ellada" [Five times as many incarcerations in Greece], Eleftherotypia, May 23, 2007, p. 17.
- Stilianidi, S., P. C. Hondrou, "Neas yenias peiramatozoa" [A new generation of guinea pigs], Eleftherotypia, Dec. 28, 2006.
- Ta Nea, Dec. 16, 1981.
- Yannarou, Lina, I Kathimerini, March 3, 2007.
- Megaloeconomou, Thodoros, "Ethniki katharsi ke exoria: I periptosi tis Lerou" [National cleansing and exile: the case of Leros], www.politikokafeneio.com.