Anxiety attacks, Oedipal fantasies, doubts about their sexuality, anorexia and drug dependence are just some of the problems that plague the children of mafia bosses. But never in the past have they dared to seek help from outside the Family, let alone allowed a stranger to help them to delve into their deepest subconscious.
According to a book just published in Italy, How the Mafia Is Changing, at the bottom of each case is an individual identity crisis provoked by a collective crisis of the mafia. It is based on detailed case studies of 40 youngsters in Palermo and other Sicilian cities who have been treated by psychologists and therapists at local health centres. Only those belonging to fully fledged mafia families were included.
The co-ordinating author, Professor Girolamo Lo Verso, says the phenomenon is recent - the first cases date from 1995 - and the decision to break the mafia law of omerta, or silence, is as significant as the psychological disturbances they present. The cases examined by health service psychotherapists reveal youngsters pushed to the edge as the invincibility of the Cosa Nostra was undermined by the police and pentiti (supergrasses).
Daniele, the youngest son of an important mafia family, aspired to something other than a career with the mob. He is obsessed with his body, and if on leaving the gym he feels less muscular than usual, he will go home and lie on his bed for the day to save energy.
Gianni, whose mafioso father died when he was young, was fought over for years by his mother and his paternal relatives. At 17 he was sworn into the organisation as a heavy, intimidating small businessmen into paying protection money. He became a heroin addict, but when he wanted to check into a detoxification centre, the Family forcibly took him away.
While young males suffer the stress of family expectations that they will go into the mafia, girls are also feeling the strain. "Once I could have walked through our village stark naked, and no one would have dared look at me," recounted one daughter of a powerful mobster. "Now I am vulnerable and fearful. I feel like I am a nothing."
Freud would have had a field day with the recurrent obsession with the father, who in the mafia culture has always been God Almighty. Recently that confidence in the omnipotence of Papa has been somewhat dented. Often he is in isolation serving a life sentence, or has begun collaborating with police, or triggered family feuds by killing relatives because they have become informers.
"There is immense conflict between the ideal and real father," said Prof Lo Verso. "Where once these kids could expect respect, now they are getting a hard time, either because their father is no longer powerful or because the social climate is changing."
The psychotherapists say that they would normally suggest family therapy, but in Sicily that is unthinkable. Forget Tony Soprano, the New Jersey mobster portrayed by James Gandolfini in The Sopranos, who shares his feelings of inadequacy with his therapist.
"No man of honour would dream of going to a psychotherapist. It is completely alien to their mindset. The closest they might come to it is confession to a priest, which is a far cry from analysis," said Prof Lo Verso. He also dismisses the film Analyze This, in which Robert De Niro's anxiety-ridden mobster consults a shrink, as Hollywood nonsense.
Even the family members who did seek help were unusual, he added. "Curiously, in almost all our cases there was a precedent of rebellion in the family, for example an aunt who had moved north and married a non-mafioso. If we imagine Cosa Nostra as a single psychic field, a world where everyone thinks the same thing, we can see that if there is a crack, albeit a tiny one, there are more likely to be several."
While the Cosa Nostra is as powerful and ferocious as ever, it has suffered some heavy blows in the past seven years. After the 1992 car-bomb murders of judges Giovanni Falcone and Paolo Borsellino, the Italian state went on the offensive against organised crime. Among those rounded up was Toto Riina, boss of bosses, who had been living undisturbed with his family in Palermo for 20 years, and other leaders such as Nitto Santapaola Giovanni Brusca and Vito Vitale.
While to some extent Sicily has shaken off its apathetic acceptance of the mafia, the most damaging change has been the dramatic increase in the number of pentiti, mafiosi betraying their former colleagues. Their decision to switch sides has tested the loyalty of their kin, torn between the blood family and the mafia clan.
Now mothers often accompany their distressed offspring to the clinic, says Prof Lo Verso. "The mothers' role in Cosa Nostra used to be that of passing on mafia values. With many mafia families in difficulty, women are now reassuming their true maternal role."
Another sign of the old values crumbling is the sharp rise in drug addiction among mafia offspring. The Cosa Nostra has always made a fortune out of heroin, but until recently it was inconceivable that their children should be users. However, the mafia's use of their youngsters as middle-level dealers or couriers has put temptation in their way. "They are effectively exiled, and in reality ought to be killed as they are a security risk. However, there are simply too many of them for that," says Prof Lo Verso matter-of-factly.