GUEST EDITOR'S NOTE
The field of the history of psychiatry in Brazil took shape almost concomitantly with development of the field per se. As early as the late nineteenth century, Pedro II Asylum (Hospício de Pedro II) was subject to review when Teixeira Brandão wrote the article "Os alienados do Brasil" (The insane in Brazil) for publication in the Arquivos Brasileiros de Psiquiatria, Neurologia e Ciências Afins (1886). Underpinning his argument with a retrospective examination of activities at the asylum, the author took exception with Santa Casa de Misericórdio Hospital's 'interference' in a domain he felt belonged strictly to psychiatry. A bit later, in the early twentieth century, Juliano Moreira (1903) wrote a history of psychiatric care in Brazil, in which he described the status of its institutions (Notícia sobre a evolução da Assistência a Alienados, Arquivos Brasileiros de Neuriatria e Psiquiatria). Other physicians continued in this historiographic tradition, highlighting the field's origins and early heroes and thereby underscoring the 'evolution' and 'triumph' of modern psychiatry.
A new wave of interest in the history of psychiatry got underway in the latter half of the 1970s, attracting not only professionals from the field itself but philosophers, social scientists, and historians as well. With Foucault as a reference, the traditional factual, developmental description of the history of psychiatry in Brazil was supplanted by a problematization of the context in which psychiatric discourse is produced and by an analysis of how it relates to the disciplinary devices and technologies of power applied to the mad, as Patrícia O'Brien made so clear in her article "A história da cultura de Michel Foucault" (Michel Foucault's history of culture; A nova história cultural, São Paulo, Martins Fontes, 2006, 2nd ed.).
Some of the works published in Brazil during this period became seminal references for subsequent generations, such as Roberto Machado's Danação da norma (Rio de Janeiro, Graal, 1978) and Jurandir Freire Costa's Ordem médica e norma familiar (Rio de Janeiro, Graal, 1979) and História da psiquiatria no Brasil (Rio de Janeiro, Xenon, 1989). These were followed by studies on madness where the interpretative aspect of history was on center stage. Focused especially on Brazil's earliest psychiatric institutions, the latter research analyzed the strategies for controlling individuals and entire populations that were adopted by social medicine in general and by psychiatry in particular.
Over the past thirty years, the history of psychiatry has traveled varied paths, intersecting with the history of the sciences and culture (including the history of literature and art) and with other lines of thought within social history, sociology, and anthropology. Foucault's influence can still be felt but more recent generations have witnessed not only a critiquing of the first round of texts written from this perspective but also a marked expansion of the field's theoretical and methodological references, objects, approaches, and sources, as Flavio Edler demonstrated in "A medicina brasileira no século XIX" (Brazilian medicine in the nineteenth century, Asclepio, Madrid, v.1, n.2, 1998).
Still, according to a study conducted by Lima e Holanda (História da psiquiatria no Brasil: uma revisão da produção historiográfica, 2004-2009, Estudos e Pesquisas em Psicologia, Rio de Janeiro, v.10, n.2, 2010), we can identify certain topics that have received special attention from area scholars: the shaping of thought in psychiatry, psychoanalysis, and psychology; institutional history and the process of institutionalization of the mad; psychiatry and processes of subjectivation; and psychiatric reform.
At the same time, historical and philosophical studies have not paid particular note to the specific language of psychiatry, the topic of only a scant number of "internalist" studies that naturalize the pathological and/or biological as well as their descriptions. In line with Sontag (Illness as metaphor, New York, Farrar, Straus and Giroux, 1978) and Peset (La historia de la psiquiatría vista por un historiador, Atopos, 2003), we must bear in mind that the authors who proposed disease categories or reproduced them within their psychiatric institutions were themselves the spokespeople of cultural constructs. So their biological, natural narratives tend to hide the history of patients who were labeled, or even fabricated, within the framework of these categories - a history that has been written collectively by physicians, patients, and other social actors, including historians.
The proposal to analyze the most important psychiatric diagnoses coming out of Brazil's National Asylum for the Insane (Hospício Nacional de Alienados) during Juliano Moreira's tenure as its director (1903-1930) seeks to arrive at a conceptual history that conjoins the historization of these diagnoses with the era's linguistic, social, political, institutional, and cultural frameworks. This proposal implies that the diagnostic process does not simply represent the progress of knowledge about a certain disease but rather - as Berrios has suggested (Classificações em psiquiatria, Revista de Psiquiatria Clínica, São Paulo, v.35, n.2, 2008) - the extension to mental illness of the beliefs of a given era.
With this goal in mind, we invited a number of authors to explore articles published in the Arquivos Brasileiros de Psiquiatria, Neurologia e Ciências Afins on the most prevalent diagnoses made at the National Asylum in the first three decades of the twentieth century. This issue of História, Ciências, Saúde - Manguinhos presents these articles along with original analyses of their content.
Three of the articles in the Analysis department look at diagnoses that underline the relation between madness and dangerousness. Focusing on epilepsy, Margarida de Souza Neves teases out the voices of patients between the lines of texts written by Jefferson de Lemos in 1915, offering us fascinating insight into the stances of this physician and ardent supporter of positivism. Fernando Dumas and Ana Carolina Verani study the diagnosis of alcoholism, taking as their point of departure Juliano Moreira's (1905) ideas about the need to house alcoholics and epileptics in special colonies. Using the memoirs of writer Lima Barreto as a counterpoint to psychiatric knowledge, these authors show how alcoholic psychosis was seen as a 'social disease' and was linked to control of the lower classes' customs, practices, and living conditions. Sérgio Carrara and Marcos Carvalho use an article by Ulisses Vianna, published in 1919, to illustrate the impact that another disease category - syphilis - had on psychiatric thought, especially in strengthening the organicist or somatological concepts of mental illness and adjusting them to the new scenario created by bacteriology.
A second group of diagnoses chosen for analysis were the subject of disagreement among doctors at the asylum, with some of these diagnoses gaining hegemony and others falling by the wayside over the course of these three decades. Ana Venancio probes the controversy between the categories of dementia praecox and schizophrenia, based on the 1929 articles of H. Roxo and Murillo Campos, respectively. In Silvia Alexim Nunes' commentary of a 1909 article by Antônio Austregésilo and in Rafaela Zorzanelli's examination of a 1916 article by H. Roxo, readers will also have the opportunity to see how the disease categories of hysteria and psychasthenia - again, respectively - were prevalent diagnoses for female patients on asylum medical records through the late 1910s. But by the late 1920s these two categories had been replaced by manic depressive madness (the topic of Afrânio Peixoto's 1905 article) and manic depressive psychosis (addressed by Adauto Botelho in 1929), as Joel Birman signals in his essay in this issue.
In the department Sources, Rafaela Zorzanelli studies an article published by Dom Justino in Arquivos Brasileiros de Psiquiatria, Neurologia e Ciências Afins in 1907, which documents the disappearance of another category from patients' medical records at the asylum: neurasthenia. And in Ana Oda's study of a 1905 article by Afrânio Peixoto and Juliano Moreira, she explores how these two physicians' hearty devotion to Kraepelin's nosography can be linked to increased diagnoses of paranoia.
The third set of articles explores diagnoses found in differing fields of medical records from the asylum during this period, at times evincing unmistakable signs of madness, at other times justifying or essentializing the subject's symptoms, and at still other times in the form of the diagnosis itself. Luiz Fernando Dias Duarte describes the diagnosis of nervousness as addressed in Henrique Roxo's 1916 article. In Octavio Serpa Junior's examination of the case of a "Brazilian black man, son of Africans," that is, a "degenerate" investigated by Murillo Campos (1924), the author offers a review of the different theories on degeneration that had been in vogue since the nineteenth century. Lastly, Sandra Caponi takes us to the heart of an article on degeneration written by Emil Kraepelin himself, the German psychiatrist whose ideas influenced a good share of the thinking found in the sources that form the object of this issue. Another contributor to this issue is Simone Santos de Almeida e Silva, a doctoral candidate at Casa de Oswaldo Cruz's Graduate Studies Program who has written a research note on physician Antônio Gonçalves Gomide, one of the introducers of mental medicine to Brazil.
The department Sources also includes two essays related to the articles from Arquivos Brasileiros de Psiquiatria, Neurologia e Ciências Afins and to their analyses. In the first, Cristiana Facchinetti, Priscila Cupello, and Daniele F. Evangelista tell the story of the periodical itself. In the second, Facchinetti, Andréa Ribeiro, Daiana C. Chagas, and Cristiane Sá Reis provide information on other sources on the National Asylum for the Insane: clinical documents, ministerial reports, and images gathered during their research into the everyday workings of this institution, which are referenced in databases and will soon be available in digital format.
The current issue of História, Ciências, Saúde - Manguinhos is the first ever devoted entirely to the history of psychiatry. We hope that the featured period articles along with these pioneer analyses will prove of great value to other researchers in this very dynamic field of study and will stimulate new, original hypotheses and lines of research.
Cristiana Facchinetti
Researcher at the Oswaldo Cruz Foundation's Casa de Oswaldo Cruz
Publication Dates
-
Publication in this collection
01 Feb 2011 -
Date of issue
Dec 2010
