By Jonathan Ablard (Ithaca College)

Manuella Meyer’s Reasoning against Madness: Psychiatry and the State in Rio de Janeiro, 1830-1944 represents an important addition to a small but growing body of English-language scholarship on Latin American and Caribbean psychiatry and mental health history.

Reasoning Against Madness examines the administrative and clinical work of psychiatrists in Rio de Janeiro but also their broader engagement in politics. Dr. Meyers considers their efforts to position themselves as instruments of modernization for the capital city and the nation more broadly. As Dr. Meyers lays out in the introduction, her study focuses on the ideas of psychiatry and its practitioners as seen in debates within the profession and with other groups, both lay and religious. She is interested in how they projected their mission to the broader public, be it politicians, ruling elites, or other interested parties.

As with many studies of the medical profession, Meyer is interested in the efforts of doctors to stake a claim to professional legitimacy and power. Brazilian psychiatrists were operating in a medical milieu where Brazilian researchers and practitioners were receiving international acclaim, especially for their work in so-called “tropical” medicine, and were generally gaining widespread acceptance from a public grateful for their successes.[1] This was not the case for psychiatrists.

As doctors, Catholic officials, Kardecist spiritists, and candomblé healers with competing visions of the causes and treatments for insanity each sought to wrest interpretive control from the others as well as from their subjects, psychiatric assertions of authority over mental illness failed to achieve broad assent. (Meyer, 3)

Brazilian psychiatrists operated in a particularly challenging social climate in which a variety of professions and communities laid claims to being authorities in healing mental anguish. Later in the book, Meyer notes that “[p]sychiatry never linked itself to Brazilian popular culture and vice versa.” (Meyer, 178). While Meyer makes a strong case about the particular ways that Brazilian society resisted psychiatric authority–especially religious traditions from Africa that had established themselves as counterweights to the oppressive system of slavery– one has to wonder how it compares with other areas of the world. I am hard pressed to find anywhere that psychiatrists enjoyed popular support. Even in Buenos Aires, with its reputation for a love for psychoanalysis, psychiatry was subject to frequent waves of suspicion from a public that came to see the profession as linked to authoritarian traditions.[2] In general, it seems that for the time period Meyer studies, most people did not really particularly trust psychiatrists. Many psychiatrists did not even particularly trust themselves and realized that the diagnosis of the same patient might change from month to month depending on a whole host of less than scientific criteria.[3]

The point, I think, is that the story is really what made Brazilian popular culture’s rejection of psychiatric authority and psychiatry’s suspicion of popular culture different from similar processes that unfolded elsewhere. Two factors that Meyer describes are salient. The first is that the African presence in Rio created a significant cultural gap between the mostly white bourgeois and modernizing impulses of the doctors and the rest of society. African-influenced traditions like candomblé were influential among all sectors of Brazilian society. It seems likely that spiritist practices like Kardecism may well have found fertile ground in Brazil because of these earlier traditions. There was also a really striking tension: on one hand, many doctors rejected the racial determinism coming out of North America and Western Europe, but at the same time operated with a set of assumptions about the racial inferiority of non-whites. The second factor which strikes me as particular to Brazil is the unique political tension between the pre-1889 imperial state and the post-1889 republican state. Many Brazilians, of all races, lamented the end of the empire and rejected, some with sword and some with pen, the modernizing and secularizing impulses of republicanism. Those tensions really shaped discussion about all public institutions well into the 1930s.

Meyer’s claims would be stronger and have great explanatory power had she engaged in a deeper way with the regional historiography. In her introduction, she introduces readers to the major works from the Spanish and Portuguese-speaking world and gives accurate renditions of their major contributions. But as a rule, Meyer does not advance our knowledge of, or interrogate, the degree to which the carioca [adjective to describe the people of Rio] case compares with other parts of the region. She notes that the Rio asylum, the first institution devoted exclusively to the care of the mentally ill, opened in 1852. Two years later, the second such institution opened in Buenos Aires, the Hospital Nacional de Alienadas. Both institutions were the battleground for conflicts between religious charities and the medical profession. There are many other parallels between Rio and the rest of the hemisphere, including efforts by psychiatrists to move beyond the asylum and develop legitimacy in the workplace and schools, and through their work in mental hygiene. Meyer notes in the conclusion, “[u]ltimately, psychiatry would not be the only field that managed the diagnosis, treatment, and prevention of mental disorders. Nor would it be the only practical guide in the management of everyday life.” (Meyer, 178)

Meyer made a good choice in not attempting to write about all of Brazil but this reader was curious to hear a bit about how the Rio case fits with the rest of Brazil. As scholars like João José Reis have observed, Afro-Brazilian majority spaces contested elite- and state-sponsored social control measures and often challenged practices like vaccination and modern burial.[4] So, is the Rio case typical? And if so, to what extent? If we cannot yet say, then there is more work to be done by other scholars! On the social side of the equation, this reader wonders whether the case of Rio is consistent with, or diverges from, other regions of Brazil. It is easy to imagine that the industrial and heavily immigrant São Paulo region might bear more in common with Buenos Aires.

Reasoning Against Madness makes a strong contribution to the field (and it is beautifully written and free of jargon) and my critiques of it point to the fact that the historiography of mental illness and psychiatry in Latin America and the Caribbean has grown rich enough that scholars perhaps need to start paying attention to cross currents of influence and of comparative frameworks. Perhaps the field is ready for comprehensive and synthetic studies of mental health history in the region.[5]

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[1] Julyan G. Peard, Race, Place, and Medicine: The Idea of the Tropics in Nineteenth-Century Brazlilian Medicine (Durham: Duke University Press, 1999). On the remarkable work of Brazilian public health doctors during the last bubonic pandemic, see Myron Echenberg, Plague Ports: The Global Urban Impact of Bubonic Plague, 1894-1901 (New York: New York University Press, 2007)

[2] Jonathan D. Ablard, Madness in Buenos Aires: Patients, Psychiatrists, and the Argentine State, 1880-1983 (Athens: Ohio University Press & Calgary: University of Calgary Press, 2008)

[3]  This is one of the most interesting premises of Cristina Rivera-Garza’s novel No One Will See Me Cry (New York: Curbstone, 2003) which she wrote while conducting research for what eventually became La Castaneda: Narrativas dolientes desde el Manicomio General de Mexico, 1910-1930  (Mexico: Tusquets, 2011).

[4] João José Reis, Death is a Festival: Funeral Rites and Rebellion in Nineteenth-century Brazil (Durham: University of North Carolina Press, 2003)

[5] An important essay that takes this task on is Cristina Sacristán, “La locura se topa con el manicomio. Una historia por contar,” Cuicuilco 16:45 (enero-abril 2009): 163-89. For public health in Latin America more generally, see Marcos Cueto and Steven Palmer, Medicine and Public Health in Latin America: A History (New York: Cambridge University Press, 2015)