Professor Carlo Lorenzo Cazzullo

Formerly Professor of Psychiatry, Milan, Italy

Professor Carlo Lorenzo Cazzullo, Emeritus Professor of Psychiatry at the University of Milan, died on 4 May 2010, aged 95. He became Professor of Psychiatry in 1959, the first to hold such a title in Italy. With his appointment, psychiatry was not only to become officially recognised as a medical subject other than neurology but also as a separate medical specialty. It was later to become a core subject by law in 1976. The relevant legislation known as Legge no 238 bears his name.

As head and founder (in 1960s) of the Istituto di Psichiatria in Milan, Professor Cazzullo generated a great many strands of scientific research, the Institute being among the first in Italy to establish international links with major research centres across the world and also adopt a scientific methodology that followed international practice. In addition to the Instituto di Psichiatria, Professor Cazzullo was also the founder of the Centre for the Study of Multiple Sclerosis of the University of Milan in 1963, and he retained an interest in this condition during his entire career.

He was born in Gallarate in the north of Italy on 30 January 1915. He gained an honours degree in medicine in 1945 after first training as an accountant. He began his career under Professor Carlo Besta, founder of the Institute of Neurology in Milan, a lasting influence.

In 1947, he went to the USA to train first at New York's Rockefeller Institute, where he undertook research in neurophysiology under Dr H. Gasser and Dr Lorente de No, and subsequently in 1948 at the Columbia University Institute of Psychiatry, where he undertook research in neuropathology under Professor A. Ferraro and Dr N. Lewes. In 1949, he went to Montreal Neurological Institute to study with Dr W. Penfield and Dr H. Jasper as a Visiting Investigator.

Professor Cazzullo was a great clinician and a brilliant teacher. He was a great advocate of the multifactorial approach in terms of causation and should be regarded in retrospect as probably the first exponent in Italy of the biopsychosocial model invented in England in the 1970s, which was to influence an entire generation of psychiatrists and which he used to teach relentlessly.

He rejected simplistic explanations based on a single cause when such explanations were fashionable in the 1970s Italy, especially with regard to the origins of schizophrenia, which he considered to be juvenile. When the anti-psychiatry movement gained ground in Milan and in the rest of the country in the early 1970s and seemed unstoppable, he successfully demolished their arguments in public speeches.

The Institute was in turn a very broad church where any serious psychiatric viewpoint was equally represented in the Institute's sections and departments. Opportunities for debate were endless and the place was a magnet for ambitious psychiatric trainees of different theoretical orientation from the beginning. His pupils were all in time to take up senior positions in Italy.

Professor Cazzullo also ought to be remembered as having a unique gift for fostering very young talent, whom he launched early on the international stage. Papers from the Milanese School regularly appeared in English in all the major international journals yet members of his research group, who were frequent speakers at national and international conferences, were often strikingly young.

He was a prolific author. His original studies include the first immunological study in the English-speaking literature of the human leukocyte antigen (HLA) system in schizophrenia in 1974 and an important study of N1-NM (N1-methylnicotinamide) as a biological marker of primary affective disorder also published in English in 1976, as well as key papers in psychopharmacology, self-harm and higher nervous activity, particularly evoked potentials. His main interest, however, was always to be the study of serious mental illness, especially schizophrenia, where he favoured an integrative approach which was to include the study of the family.

Professor Cazzullo was not a psychotherapist but believed fundamentally in the importance of the doctor-patient relationship, inviting Dr Michael Balint to Italy and introducing Balint groups in Italian psychiatry for the first time. He was also the first to admit psychiatric patients to a general hospital ward, some 15 years before the Legge 180 of 1978. This legislation, better known as Basaglia's Law, was to finally determine the closure of the mental hospitals in Italy.

Like Basaglia, he always took the view that the stigma of mental illness in Italian society needed to be reduced and that psychiatry had a responsibility to achieve this. Unlike Basaglia, however, he took the then unfashionable view that this could be achieved by providing information about mental illness to people, and was active at every level in this regard throughout his career. Unlike Basaglia, he also took the view that if psychiatry were not to be an instrument of social control, it had to have its roots firmly in academic research.

Professor Cazzullo was elected President of the Societa' Italiana di Psichiatria in 1968, were he was to continue serving for many years, and President of the Societa' Italiana di Neuro-Psicofarmacologia, which he founded in 1963. He also held a number of prestigious appointments with the World Psychiatric Association, the World Health Organization and the EEC, subsequently known as the European Union. He was to collect a vast number of honours and awards throughout his distinguished career, including the Albert Schweitzer International Gold Medal for the Humanisation of Medicine, which he was awarded by the Polish Academy of Medicine in 1996. He was a Corresponding Editor of the British Journal of Psychiatry.

In 1976, he visited China under the auspices of the Italian Foreign Office and in 1977 he was offered (by Professor H. Gantt) the post of Director and Head of the Department of Psychiatry at Johns Hopkins University, Baltimore, which he did not accept.

The Istituto di Psichiatria in Milan had a base in the Ospedale ‘Paoli Pini’, a mental hospital in a small suburb on the outskirts of Milan called Affori, which was the main centre. It was also, however, to acquire a base in the Padiglione di Guardia II in the Ospedale Policlinico, a large university general hospital in the centre of Milan. This was later to become a leading centre for the study of self-harm and a major driver for liaison psychiatry in Milan. To both trainees and trainers, the main centre was affectionately known as Affori.

I have been privileged to train in Milan under Professor Cazzullo in the early 1970s before moving to Britain. I can well remember arriving at Affori in 1972 as a young postgraduate trainee and recognising immediately that this was a very special place. I was to spend 4 exceptional years at Affori, where I also had the opportunity of studying at the nearby Istituto di Neuropsichiatria Infantile, which was ran by his second wife, Adriana Guareschi-Cazzullo, herself an esteemed professor of child neuropsychiatry. This is where I first became acquainted with Kleinian psychoanalysis, particularly the work of Dr H. Rosenfeld, which was to be instrumental in my subsequently coming to Britain.

Training under Professor Cazzullo demanded very high standards but he could be close to trainees and very supportive. When I told him of my intention to come and train in London, he was visibly disappointed. However, he also recommended immediately that I apply to train at the Royal Free Hospital, which he said he had visited the year before.

I remember him saying that he had been very impressed by the newly built mother and baby unit in the general ward, clearly another example of the type of innovation which he greatly admired.

Professor Cazzullo did not suffer fools gladly. He was a great inspirational figure and a towering giant in Italian psychiatry. He had enemies and friends like all those who make history. He was above all a moderniser. Psychiatrists whose lives and careers he helped to shape and who were touched by his incredible intellect will always miss him dearly.