3 - The Government of Psychiatry: The National Insane Asylum’s Interior Lives, 1890–94

Summary

After the declaration of the republic and the subsequent official sanction of the complete psychiatric control of the Hospicio Dom Pedro II, Brazilian psychiatrists were poised to enter a halcyon period. Under the Santa Casa's management, the belief that patients needed to choose rationality over insanity led to techniques centered on intimidation. Purging, bloodletting, blistering, physical restraints, threats, and straitjackets were employed to achieve this end. Moreover, sedatives, as any other treatment, could and would be applied with force, if necessary for punitive purpose and to improve behavior on the wards, thereby alleviating nursing strain. Morphine, hyoscyamine and hyoscine (often combined with atropine) could be turned into very powerful sleeping draughts for severely disturbed patients whose noisy behavior disturbed the ward routine.

Psychiatrists assumed the leadership of an institution riddled with accusations of torture, abuse, and neglect. Patients were known to be chained to walls, left unattended for many hours, and mistreated by staff members. Doctors who worked in the Hospício alleged that conditions were unsanitary, inhumane, and dangerous and that the asylum used painful and uncommon punishment. They noted that conditions were not only dangerous but also inadequate for the care and habilitation for the mentally ill. Some even concluded that the physical, mental, and intellectual skills of most patients had deteriorated while in the asylum. Similar to other asylums, abnormal patient behavior resulted in staff applying therapeutic interventions “to react to inmate initiative rather than the other way around.” As psychiatrists shunned the Santa Casa's system of restraint and corporal treatment, they hoped to follow a regimen of conciliatory and gentle management free from coercion and corporal punishment.

The severance of the asylum from the Santa Casa and the departure of the Daughters of Charity represented palpable markers of success for psychiatrists after a decades-long trek of professional emergence through rugged and shifting terrain. With disputes over the creation of the asylum itself behind them and struggles with religious authorities seemingly won, they embarked on an ambitious program to rehabilitate and rejuvenate the asylum into a paragon of regenerative therapy. Psychiatrists were ready to prove that they could restore the mad to sanity and fix the broken. Attuned to the latest Atlantic intellectual and psychiatric currents, Brazilian psychiatrists embraced the republican and positivist government that came to power vowing an end to the cultural stagnancy within the asylum and other imperial institutions.