Volterra Asylum: The "Mad City", NOF4, and Italy's Psychiatric Revolution

Hidden in the hills of Tuscany, just outside the medieval walls of Volterra, lie the sprawling ruins of the Ospedale Psichiatrico di Volterra. Today, images of its abandoned corridors often circulate in urban-exploration media, framing the site as a grim relic of the past. But reducing Volterra to a one-dimensional horror story betrays a far more complex historical reality. At its peak, the hospital housed more than 4,500 patients across dozens of pavilions, operating as an autonomous "city within a city." Its history is not merely a tale of brutal incarceration, but a fascinating, contradictory evolution—from a pioneering psychiatric experiment to an overcrowded institution.

Luigi Scabia's Open-Door Experiment

To understand Volterra, one must look back to the early 20th century under the direction of Luigi Scabia. During this period, the asylum was organized as a progressive "manicomio-villaggio" (asylum-village) that championed an open-door approach that sharply limited physical restraint. The institution was deeply integrated into the town's economy; there was no enclosing wall, patients interacted with local residents, and some were even hosted by families in the community.

Work therapy, or ergotherapy, was central to this model. Patients worked in agriculture, bakeries, carpentry workshops, and laundries, and were paid in a local internal currency. The system was not free of ambiguity: work was presented as therapy and could be remunerated, but the institution also benefited materially from patient labor, and later accounts describe increasingly coercive practices. Furthermore, this system operated within the restrictive framework of Italy’s 1904 psychiatric law (Law 36). The legislation authorized compulsory asylum custody for people categorized as mentally ill when considered dangerous to themselves or others, or a source of "public scandal," and when care outside an asylum was deemed impracticable. Thus, the progressive ideals of the village model were always in tension with the coercive nature of state confinement.

The Stone Book of NOF4

As the decades passed into the mid-20th century, the asylum became increasingly overcrowded, and medical interventions like electroshock and insulin therapy were introduced. Within this stricter institutional culture, a patient named Oreste Fernando Nannetti (who signed his work as "NOF4") left the site's most striking physical remnant. Over several years, he carved a continuous 180-meter-long text into the rendered exterior walls of the Ferri pavilion using a metal buckle from his institutional waistcoat.

The dense incised text, diagrams, and invented symbols describe a complex cosmic reality of telepathic communication and astral military ranks. Later scholars and Art Brut interpreters have read the "Book of Stone" not only as an expression of psychiatric distress, but also as a monumental assertion of identity within institutional confinement. While much of the original inscription has deteriorated over the decades, surviving fragments have become the focus of modern preservation efforts.

From Reform to Law 180

By the 1970s, the terrifying scale and deteriorating conditions of Italy's massive asylums triggered a national reckoning. This culminated in 1978 with the passage of Law 180. The reform is closely associated with psychiatrist Franco Basaglia, but it emerged from a broader anti-asylum movement involving clinicians, activists, patients, and politicians.

Law 180 became one of the most radical psychiatric reforms of the twentieth century. Under the new legal framework, Volterra entered a gradual process of deinstitutionalization as traditional asylum admissions ended and care shifted toward community services. The law forced Volterra to slowly empty its wards, leaving the massive pavilions to the Tuscan weather. Volterra's legacy lies in that contradiction: an institution that experimented with unusually open forms of psychiatric care while remaining part of a coercive asylum system that nationwide reform would eventually dismantle.