Beyond the Total Institution? Narrative Testimony from Leros Psychiatric Hospital Deinstitutionalization (1990–1995) and the Persistence of Institutional Violence in Contemporary Europe

The closure of European psychiatric asylums was celebrated as humanitarian progress, yet new forms of institutional violence persist through dispersed mechanisms—migrant detention centers, forensic psychiatric units, mandatory treatment orders, and increasingly selective community mental health services. This study examines the Leros psychiatric hospital deinstitutionalization (1990–1995), one of the most extreme cases of institutional violence in twentieth-century Europe, to understand what conditions enable genuine transformation versus mere displacement of confinement. This qualitative study employs narrative testimony methodology, collecting semi-structured interviews with psychiatrist Carlotta Baldi, who served as scientific consultant and training coordinator in the Italian team responsible for Leros deinstitutionalization under EU funding. Interviews were conducted in July 2025 at Leros, preserving the integrity of lived experience while integrating photographic documentation. The study follows Butler and Athanasiou’s theoretical framework on dispossession and Basaglia’s principles of institutional negation. The testimony documents systematic degradation affecting over 1200 internees, the contested process of radical transformation implementing Basaglian practices, and resistance from local economic interests dependent on the institution. The study reveals the paradox whereby territories economically dependent on confinement institutions resist closure and seek replacement with new forms of detention—Leros now hosts a massive migrant detention center. Leros demonstrates that deinstitutionalization requires not only clinical and administrative transformation but confrontation with political economies that render territories dependent on managing confined populations. The study challenges progressive narratives of linear humanitarian advancement, documenting how institutional violence persists through renamed mechanisms when collective trauma remains unprocessed and economic structures producing disposable populations remain uncontested. Findings hold implications for contemporary mental health policy, particularly regarding the re-medicalization of Italian Community Mental Health Centers and proliferation of coercive practices across Europe.