Cigare, asked the inmate, holding out his hand. Cigare? Cigare? After being shunned, he repeated Cigare? Cigare? S'il vous plait, monsieur? S'il vous plait?

The scene (from Midnight Express) featuring the two disturbed inmates was filmed on the island. The film's main actor appeared with a real patient. The intention was to recreate the atmosphere of a mental wing... or basement.

Mount Carmel Hospital's gates might, in a way, conceal a similar scene: Patients asking for change to purchase tobacco from the canteen. But the situation in general is different.

Browsing through the hospital's last annual report, one finds that a substantial number of patients have continued to lead a normal life. For instance, through the intervention of social workers, patients participate in a work scheme at the hospital. This is but the first step to a successful discharge in the more disturbed cases.

Looking closer at the annual report it becomes more and more evident that patients' experiences are incomparable to the experiences of those institutionalised in the past.

One of the evangelists documents that "a man with an unclean spirit... lived in the tombs and no one could secure him, even with a chain, because he had often been secured with fetters and chains but had snapped the chains and broken the fetters and no one had the strength to control him. Among the tombs and in the mountains he would howl and gash himself with stones".

Those suffering from a mental disease were regarded as being possessed. In fact, no treatment was available or even administered to patients housed in the island's first hospital that catered for mental illness: the Order of St John's Sacra Infermeria. Situated in Valletta, patients were housed in a common room, bound and chained to a bed. Those that turned out to be uncontrollable were transferred to the hospital's basement where patients were pinioned, their arms, and sometimes legs, chained to the chamber's walls.

During this period, patients were often beaten and attempts were made to deplete their strength. Recourse was made to opium and patients were confined in dark rooms, given cold baths, put on a reduced diet, venesected and administered purgatives and bitters.

John Howard, a philanthropist, described a scene involving eight or nine caretakers entertaining themselves with a delirious person... while breathing his last.

Those declared incurable were then transferred to the Casa Di Carità or Ospizio in Floriana. There, patients were chained to the walls of a small basement room.

A hospital was eventually established in an old mansion known as Villa Franconi but the more disturbed patients were left at the Ospizio. Situated in Floriana, the mansion was the residence of Fabrizio Franconi but following its conversion to a mental hospital it became known as Ta' Frankuni. Hence, the traditional reference to such an institution.

However, the hospital's location in a residential area was far from ideal. Curious neighbours often teased and provoked inmates. Furthermore, the hospital couldn't house more patients, regardless of the incorporation of an adjoining building. Therefore, the authorities announced a public competition for the submission of plans for another hospital.

And it was in the middle of the night that patients were transferred from the Ospizio to Mount Carmel Hospital in Attard. Here, beatings no longer occurred. Recourse to seclusion was restricted. Furthermore, cold applications to the head were used to relieve cerebral irritation and tepid baths were given to calm patients down.

Laxatives, venesection using leeches and lancing and the application of vesicants on the head and neck were used then but such practices have been abolished altogether. Medical advancements made it possible to administer regular doses of tablets to calm a patient down. Furthermore, doctors are establishing (professional) relationships with their patients, believing that discussing a problem can be more effective than a prescription.

Mount Carmel Hospital has a museum which is open to the public throughout the week. In order to have a guided tour, one should phone the chief executive officer's office on 2230 4000.