Psychiatric Power. Exclusion and Segregation in the Brazilian Mental Health System

15 Psychiatric Power

Exclusion and Segregation in the

%UD]LOLDQ0HQWDO+HDOWK6\VWHP

Marlon Miguel

1. Introduction

The history of the Brazilian psychiatric system is closely connected to the devel-RSPHQWRIWKHFRXQWU\¶VGHPRFUDWLFSURFHVVHVWKURXJKRXWWKHWKFHQWXU\± the inequalities, racism, and exclusions at the foundation of the nation, along with its instabilities, advances, and retrogressions. Brazil’s military dictator-VKLS ± UDGLFDOL]HG D V\VWHP EDVHG RQ WKH SULQFLSOHV RI SULYDWL]HG care, isolation, and segregation of mentally ill patients, transforming psychi-atric institutions into something like prisons or concentration camps. That situation would only begin to improve with the re-democratization period, in LQZKLFKGHEDWHVDURXQGWKH%UD]LOLDQ3V\FKLDWULF5HIRUPEHJDQWRDOLJQ ZLWKWKHVSLULWRIDQHZSURJUHVVLYH)HGHUDO&RQVWLWXWLRQ7KH5HIRUPPRYH-ment aimed then to transform the social perception of madness and advocated for looking at the mentally ill through the lens of citizenship. It furthermore HPSKDVL]HGWKHVXEMHFW¶VFRQFUHWHH[SHULHQFHRIVX൵HULQJWKHFXUUHQWVWDWH experienced by the mentally ill, rather than their “condition” or “disorder”; “care,” “social bonds,” and “relationality,” rather than “isolation,” were the privileged concepts. These shifts drew inspiration from anti-psychiatry and institutional reform movements in Europe, as well as some exceptional Bra-]LOLDQ ¿JXUHV VXFK DV 1LVH GD 6LOYHLUD 7KH 5HIRUP ODZ ¿UVW SURSRVHG LQ ZRXOGRQO\EHLPSOHPHQWHGLQWKHV$QGLWKDVEHHQXQGHUDWWDFN HYHUVLQFHWKHFRXSGLUHFWO\UHÀHFWLQJWKHGHGHPRFUDWL]DWLRQWKDWWKLV event unleashed. Brazil has witnessed a strong return of forced hospitaliza-tion, the use of violent treatment and the dismantling of public mental health structures.

This chapter seeks to provide a historical analysis of Brazilian psychia-WU\0\SXUSRVHKHUHZLOOEHWRHPSKDVL]HWKHLQKHUHQWFRQQHFWLRQEHWZHHQ XQGHPRFUDWLFSURFHVVHVDQGVRFLDOXQGHUVWDQGLQJVRIWKH¿JXUHRIWKH³PDG´ The structuration of the system of psychiatric care indeed would seem to be inseparable from human rights concerns and the need to consider all individu-als as worthy of care. Without a doubt, social acceptance of the “mad” is intrin-sically related to concerns for democracy, and de-democratization, for its part, EHJLQVE\WDUJHWLQJ³GHYLDQW´¿JXUHV

Psychiatric Power 251

Beyond expressing a determinate social understanding of madness, I claim WKDWPHQWDOKHDOWKPRGHOVGLUHFWO\FRQGHQVHWKHDFWXDOIRUPVRIDQXQGHPR-cratic regime. Indeed, undemoWKDWPHQWDOKHDOWKPRGHOVGLUHFWO\FRQGHQVHWKHDFWXDOIRUPVRIDQXQGHPR-cratic regimes tend to create enemies and trans-form them into pathological beings, casting them as disrupting the natural order. The image of the enemy is thus constructed through a medical vocabu-lary as a pathological intrusion, to be combatted through treatment. In present-GD\%UD]LO±DIWHUWKHFRXSDQGLQWKHPLGVWRIDQDXWKRULWDULDQFOLPDWH LQDXJXUDWHGZLWKWKHHOHFWLRQRI-DLU%ROVRQDUR±LQWHQVL¿HGGLVFRXUVHVRI pathological abnormality and the renewal of exclusionary mental health poli-cies go hand in hand, expressing a radical shift towards the de-democratization of Brazilian society.

2. Early Brazilian Psychiatry: A Project of Isolation, Racial and Social Exclusion

The history of Brazilian psychiatry is marked by the coexistence of, on the one hand, early progressive and even vanguard clinical practices, and on the other, a heavily exclusionary, violent, and carceral psychiatric system. Already in WKHV6LJPXQG)UHXG¶VZRUNZDVWKHVXEMHFWRILQWHQVHGHEDWHLQ%UD]LO DQGLQWKH%UD]LOLDQ3V\FKRDQDO\VLV6RFLHW\ZDVIRXQGHG7KHXVHRI DUWDVDWKHUDSHXWLFWRRODOVRDSSHDUVGXULQJWKLVSHULRGDQGLQ2VyULR &pVDU ZRXOG SXEOLVK KLV VHPLQDO ERRN A expressão artística nos alienados:

contribuição para o estudo dos símbolos na arteThe Artistic Expression of the Alienated: A Contribution to the Study of the Symbols in Art ± D

SXE-lication contemporary with Hans Prinzhorn’s Bildnerei der Geisteskranken :DOWHU0RUJHQWKDOHU¶V(LQ*HLVWHVNUDQNHUDOV.QVWOHU$GROI:|OÀL DQG-HDQ9LQFKRQ¶VL’art et la folie:KHUHPRVWGRFWRUVRQO\ recognized a disorder, non-sense, and absurdity, by observing the work of the mentally ill it became possible to envision a new way of examining delusions, behaviors, and pathologies. The artwork of the “mad” thus became a central LQÀXHQFHLQ%UD]LOLDQPRGHUQLVPDQGDORQJZLWK&pVDUWKHDUWLVW)ODYLRGH &DUYDOKR RUJDQL]HG LQ  WKH H[KLELWLRQ Mês das Crianças e dos Loucos Month of the Children and MadDWWKH0RGHUQ$UWLVWV&OXELQ6mR3DXOR7KLV ZDVWKH¿UVWLQDVHULHVRIH[KLELWLRQVZKHUHWKHZRUNRIPHQWDOO\LOOSDWLHQWV migrated from psychiatric institutions to the world of arts. Furthermore, with WKHVH ZRUNV &DUYDOKR VKLIWHG WKH YHU\ XQGHUVWDQGLQJ RI DUW FODLPLQJ ³WKH RQO\DUWLVDEQRUPDODUW´'H&DUYDOKRZLWK&DEDxDV

:KLOHWKHVHHOHPHQWVUHÀHFWHGWKHHPHUJHQFHRIDQHZUDGLFDOUHODWLRQDO and progressive understanding of madness, most 20th-century Brazilian psy-chiatric institutions continued operating along the lines of the grand

renferme-ment model described by )RXFDXOW2 As Foucault has shown, a radical

GLYLVLRQHPHUJHGLQWKHWKFHQWXU\EHWZHHQQRUPDODQGPDGSHRSOHZKHUHLQ the latter are to be isolated and receive treatment. A psychiatric discourse such as Philippe Pinel’s was certainly progressive for the time period, focused as it was on “liberty” and on “unchaining” the mad. However, their liberation,

252 Marlon Miguel

based on “adequate” treatment, was conditioned by disciplinary practices. In addition, Pinel proposed a correlation between “mental alienation” and the unhealthy social milieu in which the subject lived. In that sense, his argument called for the subject’s isolation from these causes. As consequence, this dis-FRXUVH SURPRWHG  LVRODWLRQ DQG  WKH LGHQWL¿FDWLRQ RI PHQWDO GLVRUGHUV with certain social milieus.

7KH¿UVWSV\FKLDWULFLQVWLWXWLRQVFUHDWHGLQ%UD]LOLQWKHWKFHQWXU\DGKHUHG to this isolationist logic while targeting particular parts of the population.3

0RUHRYHULQWKH%UD]LOLDQFRQWH[WLWFOHDUO\LQWHJUDWHGUDFLVWGLVFRXUVHV 7KH 3HGUR ,, +RVSLWDO ZDV WKH ¿UVW DV\OXP FUHDWHG LQ %UD]LO LQ 5LR GH -DQHLUR LQ  IROORZHG E\ PDQ\ RWKHUV VXFK DV WKH 6mR 3HGUR +RVSLWDO LQ3RUWR$OHJUHDQGWKH-XTXHU\&RORQLDO+RVSLWDOLQWKHVXEXUEVRI 6mR3DXOR7KHVHLQVWLWXWLRQVPDLQO\UHFHLYHGORZHUFODVV%UD]LOLDQV Following behind “schizophrenia” and “alcoholism,” the third most common FDXVHRIKRVSLWDOL]DWLRQZDV³XQNQRZQ´,%*()XUWKHUPRUHPRVW of the patients that entered an asylum would never leave. For example, under WKH GLUHFWLRQ RI )UDQFR GD 5RFKD ± DURXQG  RI WKH SDWLHQWV WKDWHQWHUHGWKH-XTXHU\+RVSLWDOZRXOGDOVRGLHZLWKLQWKHLQVWLWXWLRQ(YHQ PRUHVWULNLQJLVWKDWWKLVQXPEHUVZRXOGJRXSWREHWZHHQDQG DPRQJ EODFN SHRSOH 0DFKLQ DQG 0RWD   3DWLHQWV ZHUH RIWHQ VHQW to asylums by the police, for seemingly random reasons or simply based on “social disorder.”

The early history of Brazilian psychiatry was also marked by a eugenics SURMHFW&RVWD; 5HLVEDVHGRQWKHFRQFHSWRI³UDFH´DQGWKHFODV-VL¿FDWLRQ RI GLVRUGHUV DFFRUGLQJ WR HWKQLFLW\7KLV SURMHFW ZDV UHSUHVHQWHG E\SURPLQHQWPHGLFDO¿JXUHVLQ6mR3DXOROLNH5HQDWR.HKOFUHDWRURIWKH 6mR3DXOR(XJHQLFV6RFLHW\-RVp3DUDQKRV)RQWHQHOOH3HGUR0RQWHOHRQH 2WiYLR*RQ]DJDDQG'D5RFKDKLPVHOIRUWKH%UD]LOLDQ/HDJXHIRU0HQWDO +\JLHQHFUHDWHGLQLQ5LRGH-DQHLUR7KHGLVFRXUVHDURXQGWKH³PHQ-tal disturbances of black people” was commonplace, as was the attempt to SVHXGRGLDJQRVH³%UD]LOLDQUDFLDOUHDOLW\´5R[R-XOLDQR0RUHLUDZLWK 5HLV9HU\RIWHQWKHVHGLVFRXUVHVFRQWDLQHGFDWHJRULHVRIPHQWDO disorder associated with “race” and the “degeneration” of the human species. 6RPHSV\FKLDWULVWVVXFKDV5DLPXQGR1LQD5RGULJXHVGHIHQGHGLPPLJUD-tion control in order to progressively limit miscegena6RPHSV\FKLDWULVWVVXFKDV5DLPXQGR1LQD5RGULJXHVGHIHQGHGLPPLJUD-tion, “whitening” the %UD]LOLDQ SRSXODWLRQ DQG ZLWK LW UHGXFLQJ PHQWDO SDWKRORJLHV 5HLV ; 2GD

Eugenicist ideologies, sanitation concerns, and mental hygiene discourses weighed heavily during this period in Brazilian society, which in turn was FKDUDFWHUL]HGE\UDGLFDOWUDQVIRUPDWLRQVWKHDEROLWLRQRIVODYHU\WKH HDUO\ \HDUV RI WKH 5HSXEOLF  LQGXVWULDOL]DWLRQ VLJQL¿FDQW LPPLJUD-WLRQDQGUXUDOH[RGXV±6mR3DXORIRUH[DPSOHGRXEOHGLWVSRSXODWLRQLQWKH ¿QDO GHFDGH RI WKH WK FHQWXU\ (XJHQLFV DQG SV\FKLDWU\ ZHUH IXVHG LQ DQ attempt to reorganize urban centers, with particular concern for “pathologies RIWKHSRRU´±GHOLQTXHQF\DOFRKROLVPSURVWLWXWLRQDORQJZLWKWXEHUFXORVLV

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DQGV\SKLOLV±DQGWKHUHSHDWHGFRUUHODWLRQEHWZHHQPDGQHVVDQGUDFLDODQG SV\FKLF GHJHQHUDWLRQ /RZHUFODVV SRSXODWLRQV EHLQJ PRVWO\ EODFN RU PLV-cegenated, these ideologies associated the project of racial cleansing with PDLQWHQDQFH RI VRFLDO RUGHU DQG FULPH UHGXFWLRQ 0HGLFDO GLVFRXUVH IXQF- WLRQHGGXULQJWKHSHULRGDVDPHDQVIRU³VRFLDOGLVTXDOL¿FDWLRQRIEODFNSHR-SOH´ %LUPDQ 7KH DIRUHPHQWLRQHG HXJHQLFLVW .HKO ZKR ODWHU PRYHG WR5LRZDVDQDFWLYHPHPEHURIWKH/HDJXHIRU0HQWDO+\JLHQHLQWKHV DQGVDQRUJDQL]DWLRQZKHUHRWKHULPSRUWDQW¿JXUHVSDUWLFLSDWHGVXFKDV -XOLDQR0RUHLUD3HGUR,,+RVSLWDO¶VGLUHFWRU0LJXHO&RXWRSUHVLGHQWRIWKH 1DWLRQDO$FDGHP\ RI 0HGLFLQH &DUORV &KDJDV GLUHFWRU RI 2VZDOGR &UX] ,QVWLWXWH(GJDU5RTXHWWH3LQWRGLUHFWRURIWKH1DWLRQDO0XVHXPDQG0RQ-WHLUR/REDWRZULWHUDQGFXOWXUDO¿JXUH

7KH/HDJXHIRU0HQWDO+\JLHQHUHPDLQHGYHU\DFWLYHLQWKHVGXULQJ WKH9DUJDV(UDZKLFKVDZVHYHUDOUHIRUPVDIWHUWKH&RQVWLWXHQW$VVHP-EO\7KH/HDJXHIRUPHGDSRZHUIXOOREE\DGYRFDWLQJIRUWKHLGHQWL¿FDWLRQRI health with eugenics, and sought to turn terms such as “eugenetics,” “eufre-QLD´³HXJHQLFV´³G\VJHQLFV´LQWRFRPPRQSDUODQFH6WHSDQ7KHLU project consisted in an attempt to “extend the methods of mental hygiene to WKHHQWLUH%UD]LOLDQSRSXODWLRQ´&RVWD)XUWKHUPRUHWKHLUPHPEHUV ZRXOGRFFXS\LPSRUWDQWDGPLQLVWUDWLYHSRVLWLRQVLQ0LQLVWULHVRI(GXFDWLRQ DQG3XEOLF+HDOWKDQGWKH0LQLVWU\RI:RUN,QWKH$VVLVWDQFHIRU3V\-FKRSDWKVDQGIRU0HQWDO3URSK\OD[LVZDVFUHDWHG7KLVPDUNHGDPRPHQWLQ ZKLFKSV\FKLDWU\DFTXLUHGIRUWKH¿UVWWLPHDSURPLQHQWVWDWXVDPRQJRWKHU areas of public health.

7KHVDOVRVDZWKHHPHUJHQFHRIWKH,QWHJUDOLVWVDNLQGRIORFDOIDVFLVW PRYHPHQWOHGE\WKHSROLWLFDODQGOLWHUDU\¿JXUH3OtQLR6DOJDGR&KDUDFWHUL]HG by strong anti-communist sentiments, the movement disseminated a discourse LQ ZKLFK FRPPXQLVWV ZHUH LGHQWL¿HG ZLWK SDWKRORJLHV RU LQIHFWLRXV DJHQWV 0RWWD  ± _{This discourse would return, even stronger, decades}

ODWHUGXULQJWKHSUHFRXSHUD

The Estado Novo ± ZRXOG HPSKDVL]H WKH SUDFWLFH RI SUHYHQWLYH medicine, education, and individual care, while at the same time suppressing more openly racist and eugenicist discourse.5 _{It also confronted the Integralist}

PRYHPHQW)XUWKHUPRUHDIWHUWKH%UD]LOLDQVWDWHFHQWUDOL]HGDOOSXEOLF VDQLWDU\DGPLQLVWUDWLRQDQGFUHDWHGWKH1DWLRQDO6HUYLFHRI0HQWDO'LVRUGHUV 61'0 7KH %UD]LOLDQ +HDOWK &RGH SURSRVHG LQ  DOVR H[SOLFLWO\ FRQ-demned terms such as asilo and hospícioDV\OXPDQGKRVSLFHSURSRVLQJWR UHSODFHWKHPZLWK³KRVSLWDO´8QGHU-XVFHOLQR.XELWVFKHFN¶VJRYHUQPHQWWKH 61'0ZRXOGODWHUH[SDQGSV\FKLDWULFVHUYLFHVDFURVVWKHFRXQWU\LQDQH൵RUW to prevent dislocation, with patients having to travel to urban and economic centers, as well as reducing hospital over-population. Finally, this period saw an important expansion of medical posts providing outpatient care for the pre-vention of mental disorders.

While this broad trend saw a marked shift towards prevention in the mental KHDOWK¿HOGWKDWVDPHSHUVSHFWLYHZDVXQGHQLDEO\K\JLHQLFDQGUDFLVWDWLWV

 Marlon Miguel

foundation. And that same view would continue to structure Brazilian psychi-atric policy for years to come.

3. Nise da Silveira: An Exception to the Psychiatric Order

:KLOHHDUO\%UD]LOLDQSV\FKLDWU\ZDVJHQHUDOO\DGLVPDOD൵DLURQHLPSRUWDQW ¿JXUHUHSUHVHQWHGDQH[FHSWLRQ'U1LVHGD6LOYHLUD%RUQLQ0DFHLyLQ VKHEHJDQZRUNDVDSV\FKLDWULVWLQWKHHDUO\VLQ5LRGH-DQHLURDWWKH 3UDLD 9HUPHOKD 3V\FKLDWULF +RVSLWDO LQ WKH 1DWLRQDO 'HSDUWPHQW RI 0HQWDO +HDOWK'LQVDPDQGLQWKH%UD]LOLDQ)HPLQLVW8QLRQ8)%$IHOORZWUDYHOHU RIWKH&RPPXQLVW3DUW\DQGPHPEHURIWKH8)%VKHZDVSHUVHFXWHGE\WKH 9DUJDV UHJLPH KHOG LQ SULVRQ IRU  PRQWKV DQG VSHQW VHYHUDO \HDUV OLYLQJ underground. She was eventually accepted back into the public health system, LQDQGEHJDQZRUNDWWKH3HGUR,,+RVSLWDO$OWKRXJKDUHDGHURI)UHXG KHUZRUNLVEDVHGUDWKHURQWKDWRI&DUO*XVWDY-XQJ±ZLWKZKRPVKHFRUUH-VSRQGHG±DVZHOODVWKHZRUNRI$QWRQLQ$UWDXGDQG6SLQR]D±ZKRVHZRUN she read with particular devotion during her time in prison.

,QLQFROODERUDWLRQZLWKWKHDUWLVW$OPLU0DYLJQLHU6LOYHLUDRSHQHGD painting studio at the Pedro II Hospital. There, they organized exhibitions and HQFRXUDJHG¿JXUHVRIWKHDUWZRUOGWRYLVLW±DPRQJWKRVHLQYLWHGZHUH%HOJLDQ FULWLF/pRQ'HJDQGDQG%UD]LOLDQFULWLF0iULR3HGURVDDVZHOODVWKHSDLQW-ers Ivan Serpa and Abraham Palatnik. The collaboration with Pedrosa would SURYHHVVHQWLDOWRWKHVWXGLRDQGODWHUWRWKHIRXQGDWLRQLQRIWKH0XVHXP of Images of the Unconscious. The museum, housed within the hospital, con-tained the work of Silveira’s patients, which she considered crucial instruments IRUIXUWKHUVFLHQWL¿FVWXG\RISV\FKRVLV6LOYHLUDHPSKDVL]HGWKHFUHDWLRQRID favorable working environment for artistic endeavors and organized perma-nent exhibitions. The exhibition space was not however conceived for teaching art, but rather as encouraging the patients’ artistic production.

Silveira managed, against great adversities, to develop her work over the course of several decades. She struggled constantly with the so-called “modern” psychi- DWULFPHWKRGVLQVXOLQVKRFNWKHUDS\&DUGLD]ROLQGXFHGFRQYXOVLRQVSV\FKRVXU-JHU\DQGORERWRP\WKDWZHUHFRPPRQSUDFWLFHGXULQJWKHSHULRG1RWRQO\WKDW her patients’ exhibitions too served to call attention to the violent practices and precarious conditions of psychiatry. Here too Pedrosa played a vital role. His con-ception of modern art was crucial for the critique he would develop of rationality, as well as the methods of modern psychiatric institutions. Underlying Pedrosa’s critical project was an interesting tension: he insisted on the autonomy of form, paying close attention to the work of art, while simultaneously critiquing bour-geois rationale justifying the exclusion of the mentally ill. The “mad” are here neither outside modern art nor a model of transgression, but as Pedrosa puts it, echoing Goethe’s Denn was innen, das ist außen³7KH\>SDWLHQWV@VHHHYHU\WKLQJ VLPXOWDQHRXVO\IURPLQVLGHDQGIURPRXWVLGH´3HGURVD

Silveira’s “rebellious psychiatry,” as she herself described her method in her XQ¿QLVKHGDXWRELRJUDSK\0HOORLVQRWMXVWWKHLQWHJUDWLRQRIPDGQHVV

Psychiatric Power 255

into humanistic practices, but, based on her Spinozian monistic “unity of WKLQJV´ 'D 6LOYHLUD  ZLWK 0HOOR   LW LV DOVR D FULWLFDO LQTXLU\ into the separation of nature and culture, and the hierarchical categorization of WKLQJV±DQGZLWKWKHPKXPDQV+HUSV\FKLDWULFPHWKRGFRQVLVWHGLQLQYHV-WLJDWLQJDSRVVLEOHUHFRQ¿JXUDWLRQRIOLYLQJWKLQJVDFFRUGLQJWRWKHLUVLQJXODU and plastic forms. For her, “creative activity” mobilizes “several aspects of WKH SV\FKH´ DQG LQ SDUWLFXODU LWV ³RUGHULQJDXWRKHDOLQJIRUFHV´ LELG  Furthermore, she recognizes the necessity, when treating mental disorders, of UHFRQQHFWLQJ SDWLHQWV ZLWK D VRFLDO HQYLURQPHQW LQFRUSRUDWLQJWKH VX൵HULQJ body into a certain community. Hence, we might call her a kind of “ecological GRFWRU´Pordeus 2018

Silveira’s practice and thought anticipated by several decades many of the principles that would later appear in the Brazilian Psychiatric Reform, as well as resonate with the global institutional reform and anti-psychiatry move-ments._{$OUHDG\LQVKHFUHDWHGWKHCasa das Palmeiras to host former}

patients of psychiatric institutions. She advocated for the importance of the

externato, or outpatient halfway house, crucial for the deinstitutionalization of

patients. This dimension will prove central to the Reform project, as we shall soon see.

,Q6LOYHLUDVHQWDOHWWHUWRWKHQ3UHVLGHQW-kQLR4XDGURVSURSRVLQJD national reform work program. Her aim there was to completely rethink the existing psychiatric structure, focusing on the isolationist practices of hospitals:

The hospital is reinforcing the pathology, because it does not help at all in re-establishing connections between the patient and their milieu, from which they are being separated because of the pathology. . . . The Hospital

EHFRPHVDQH[WUHPHO\H൶FLHQWDSSDUDWXVIRUWKHFKURQL¿FDWLRQ>FURQL¿-cação@RIGLVHDVH

'D6LOYHLUDZLWK0HOOR :KLOH4XDGURVH[SUHVVHGLQWHUHVWLQ6LOYHLUD¶VSURSRVDOKHUHQRXQFHGLWVRPH days later and no further progress was ever made. Her project would be com-pletely forgotten, existing for decades as an exceptional, alternative project.

4. Barbacena and the Military Dictatorship Years

The structure of Brazilian psychiatric institutions would remain stable from WKHHQGRIWKH9DUJDV(UDXSWRWKHPLOLWDU\FRXS,Q%UD]LOKDG SV\FKLDWU\KRVSLWDOVRIZKLFKZHUHSULYDWHDQGSXEOLF±WKRXJKSXEOLF KRVSLWDOVZHUHUHVSRQVLEOHIRURIKRVSLWDOEHGV,QWKHQXPEHURI total hospitals approached 135, with 81 hospitals in the private sphere and the UHPDLQLQJSXEOLFDFFRXQWLQJIRURIKRVSLWDOEHGV7KH\HDUVIROORZ-ing the military coup would see the radical redistribution of private and public KRVSLWDOV E\  WKH SULYDWH KRVSLWDOV ZRXOG UHSUHVHQW  RI KRVSLWDO EHGV3DXOLQ7XUDWR

 Marlon Miguel

Indeed, the psychiatric model implemented during the Brazilian dictatorship ±ZDVEDVHGRQWKHSULQFLSOHRISULYDWHFDUH7KHVWDWHLWVHOILQYHVWHG in the private system, providing the working classes with access to these ser-vices through social security policies, subcontracting those same serser-vices ZLWKLQ SXEOLF KRVSLWDOV 7KH SXEOLF V\VWHP ZDV WKXV QHJOHFWHG UHD൶UPLQJ once again, the idea of the public psychiatric hospital as a place of isolation, VHJUHJDWLRQDQG³FKURQL¿FDWLRQ´RISDWLHQWVWUHDWHGLQWKHVHLQVWLWXWLRQV±D ]RQHRI³VRFLDODEDQGRQPHQW´Biehl 2005$WWKHVDPHWLPHDQGEHFDXVHRI WKHFDWDVWURSKLFVWDWHRISXEOLFVHUYLFHVWKHGLVFRXUVHHPSKDVL]LQJWKH³H൶-ciency” of the smaller, private services began to gain ground.

The privatization of the psychiatric sector was accompanied by a huge LQFUHDVHLQKRVSLWDOL]DWLRQV%HWZHHQDQGWKHKRVSLWDOSRSXODWLRQ VZHOOHGE\±DOWKRXJKWKHVDPHQXPEHUMXPSHGWRLQSULYDWHLQVWLWX-WLRQVidem3ULYDWHKRVSLWDOEHGVIXQGHGE\WKHVWDWHLQFUHDVHGIURP LQWRLQUHDFKLQJLQWKHQXPEHURISV\FKLDWULF VSDFHVODFNLQJLQSURSHUKRVSLWDOEHGVleito-chão, translated euphemistically DV³JURXQGEHGV´FOLPEHGWRLQWKHSULYDWHKRVSLWDOVidem; Resende 7KHVHQXPEHUVDUHVLJQL¿FDQWLQVRIDUDVWKH\DOVRUHYHDOWKHGRPLQDQW perspective structuring psychiatric discourse: hospitalization. The dominant psychiatric ideology during this period held that the proper place for the mad was away from the public eye and enclosed in the asylum. Lacking in other clinical services to assist, host, and treat patients with mental disorders, the only remaining option was to send them to hospitals. And, furthermore, hos-pitalization in this discourse implied long-term hoshos-pitalization. As all these transformations were taking place, the psychiatric system became a very lucra- WLYHEXVLQHVVIRUSULYDWHKRVSLWDOVUHFHLYLQJPRQH\IURPWKHVWDWH±EXWODFN-LQJ LQ JRYHUQPHQW RYHUVLJKW ± IRU WKH SDWLHQWV WKH\ UHFHLYHG7KH SHULRG LQ TXHVWLRQWKXVEHFDPHNQRZQDVWKHERRPRI³PDGQHVVLQGXVWU\´0HOOR; &HUTXHLUD; Amarante 2011

6WDWLVWLFDO¿JXUHVIURPWKHSHULRGDOVRUHÀHFWWKHDEVHQFHRIVWDWHFRQWURO ,Q WKH V LW ZDV FDOFXODWHG WKDW PRUH WKDQ  KRVSLWDOL]HG SV\FKLDW-ric patients lacked a bed, that hospitalization periods on average lasted seven PRQWKVDQGWKDWWKHPRUWDOLW\UDWHDWSV\FKLDWULFIDFLOLWLHVZDVWLPHVKLJKHU WKDQLQRWKHUKRVSLWDOVIRUFKURQLFGLVHDVHV3DXOLQ7XUDWR$OOWKH while, given the military dictatorship, any type of dissenting voice against the VWDWHRIDV\OXPVZDVRIWHQSDLGZLWK¿ULQJVSHUVHFXWLRQDQGH[SXOVLRQIURP public service.

Higher rates of hospitalization during the dictatorship were linked in turn with the shift towards the so-called preventive orientation of prior decades, a SROLF\WKDWDVZHKDYHVHHQZDVSUHPLVHGRQDUDFLVWPRGHO1RWXQOLNHWKH PRGHOLPSOHPHQWHGE\WKH8QLWHG6WDWHVLQWKHVSV\FKLDWU\DLPLQJDW SUHYHQWLQJVRFLDOLQVWDELOLW\WDUJHWHGFHUWDLQSRSXODWLRQSUR¿OHV,QWKH86$ these were segregated minorities: black and poor people, hippies and the drug GHSHQGHQW7KLV SKHQRPHQRQ UHÀHFWHG D YHU\ SUREOHPDWLF ³FRQFHSWXDO VOLS-page,” wherein “social deviation, a by-product of the individual’s political and

Psychiatric Power 

economic maladjustment” was correlated with “the behaviour of the mentally LOO´ %LUPDQ &RVWD  7KH SV\FKLDWU\ LQ VHUYLFH RI WKH VWDWH DQG DV ³PDQDJHURIULVNV´&DVWHOEHFRPHVDGDQJHURXVWRRODQGWKHLQÀXHQFH of this ideology is very present in the Brazilian context.

7KH V DOVR ZLWQHVVHG WKH XSGDWLQJ RI WKH FRPPXQLVWDVHQHP\ GLV-course. This same discourse was accompanied by the revival of a discourse FRQFHUQLQJWKHSDWKRORJLFDODQGLQIHFWLRXVLQ¿OWUDWLRQRIIRUHLJQDJHQWVUHS-resenting a disruption of a supposedly natural, organic order. These elements, WRJHWKHUOHQWZHLJKWWRDGLVFRXUVHLQZKLFKWKH¿JXUHRIWKH³PDG´ZDVVWLJ-matized, while expanding on the notion of madness and deviation and empha-sizing the need for exclusion and isolation.

Perhaps no other institution better represents the dramatic situation of the %UD]LOLDQSV\FKLDWULFV\VWHPDVWKH&RORQLDO+RVSLWDORI%DUEDFHQDLQ0LQDV *HUDLV8SRQKLVYLVLWWR%DUEDFHQDLQ)UDQFR%DVDJOLDFRPSDUHGWKH KRVSLWDOWRD³FRQFHQWUDWLRQFDPS´$UEH[DQGLQGHHGLWZDVD SHUIHFW H[DPSOH RI D ³WRWDO LQVWLWXWLRQ´ *R൵PDQQ  7KH KRVSLFH ZDV IRXQGHGLQDORQJZLWKWKHFUHDWLRQRIWKHFRXQWU\¶V¿UVWSV\FKLDWULFKRV-SLWDOVDQGZDVGHVLJQHGDFFRUGLQJWRWKH³FRORQ\´PRGHO±LVRODWHGIURPWKH urban centers, the asylum would be a place where patients were meant to work as part of their treatment, according to the motto Labor/Praxis Omnia

Vin-cit:RUN&RQTXHUV$OO7KHFRORQ\KDGLQLWLDOO\EHHQSURMHFWHGWRKRVW

SDWLHQWV'XULQJLWV¿UVWWKUHHGHFDGHVDOPRVWRIWKHKRVSLWDO¶VIXQGLQJ FDPH IURP WKH FRPPHUFLDOL]DWLRQ RI SURGXFWV KDUYHVWHG WKHUH EHDQV FRUQ SRWDWRHVHWFDVZHOODVIURPWKHSDWLHQWV¶ODERUIRUFHHPSOR\HGIRUDYDULHW\ of activities, such as road maintenance. The colony started to become famous DURXQG  DQG JRW TXLFNO\ RYHUSRSXODWHG$URXQG WKLV SHULRG LW ZRXOG DOUHDG\KDYHDERXWSDWLHQWV-RVp&RQVHQVR)LOKR0LQDV*HUDLV6WDWH 1DWLRQDO 'HSDUWPHQW RI 1HXURSV\FKLDWU\¶V GLUHFWRU DW WKDW PRPHQW GHFLGHG to replace the usual hospital beds by “ground-beds” made of grass, something WKDWZRXOGEHODWHULQDGRSWHGE\RWKHUDV\OXPVRIWKHVWDWH

The situation would progressively worsen in the following decades, with LQFUHDVLQJO\PRUHSHRSOHVHQWWRWKHFRORQ\7KHDV\OXPEHFDPHD¿WWLQJV\P-bol for the use of psychiatry as tool for power, beyond its supposed treatment RIPHQWDOLOOQHVV,WLVFDOFXODWHGWKDWRIWKHSDWLHQWVKRVSLWDOL]HGGLGQRW HYHQKDYHDSURSHUPHQWDOGLVRUGHUGLDJQRVLV$UEH[3DWLHQWVZHUHVHQW there for a variety of unrelated reasons: epilepsy, alcoholism, homosexuality, SURVWLWXWLRQ VRFLDO GLVRUGHU RU WR XQEXUGHQ LQÀXHQWLDO PHPEHUV RI VRFLHW\ 0DQ\SUHJQDQWZRPHQZHUHDOVR³KRVSLWDOL]HG´GXULQJWKDWSHULRGWKHYLFWLPV RIUDSH±E\WKHLUERVVHVORYHUVHWF±RUWKHGDXJKWHUVRILQÀXHQWLDOODQGRZQ-ers who had engaged in premarital sex. At least 30 babies were born inside the asylum and were taken from their mothers.

3HRSOHZHUHRIWHQVHQWWR%DUEDFHQDE\WUDLQV±WKHVRFDOOHGtrem dos

lou-cosWUDLQRIWKHPDG±WKDWZRXOGOHDYHFURZGHGDQGUHWXUQHPSW\0RVWRI

the individuals were sent there to die or to remain enclosed forever. With one SV\FKLDWULVWIRUHYHU\SDWLHQWVRYHUSRSXODWHGVSDFHVIULJKWIXOFRQGLWLRQV

258 Marlon Miguel

IRRG DQG FORWKLQJ VKRUWDJHV LW LV EHOLHYHG WKDW RYHU WLPH PRUH WKDQ  people died inside the colony. As part of that same “madness industry,” 1,823 FRUSVHVZHUHVROGEHWZHHQDQGWRPHGLFLQHIDFXOWLHVPRVWRI WKHPWRWKH)HGHUDO8QLYHUVLW\RI0LQDV*HUDLVArbex 2018

,Q  ZKHQ 1LVH GD 6LOYHLUD VHQW KHU UHIRUP ZRUN SURJUDP WR WKHQ 3UHVLGHQW -kQLR 4XDGURV SKRWRJUDSKHU /XL] $OIUHGR DQG MRXUQDOLVW -RVp Franco published an important article in the O Cruzeiro newspaper docu-PHQWLQJ WKH DV\OXP¶V VLWXDWLRQ 4XDGURV UHDFWHG LPPHGLDWHO\ E\ SURSRVLQJ to improve the institution’s condition, but after his resignation, there was no IROORZXS1RRWKHUMRXUQDOLVWZRXOGHQWHUWKHLQVWLWXWLRQDJDLQXQWLODQG WKHHQWLUHD൵DLUUHPDLQHGFRPSOHWHO\EORFNHGGXULQJWKHPLOLWDU\GLFWDWRUVKLS¶V ³\HDUVRIOHDG´1HZGRFXPHQWDWLRQZRXOGRQO\EHSURGXFHGLQZLWKD series of articles by Hiram Firmino for the Estado de Minas newspaper, and with the documentary Em nome da razãoIn the Name of ReasonE\+HOYpFLR Ratton. These documents, Basaglia’s public pronouncements, and the move-PHQWIRUWKH5HIRUPZRXOG¿QDOO\VWDUWWRH[HUWUHDOSXEOLFSUHVVXUHRQWKH treatment of Barbacena.

While Barbacena represents an extreme case, it also remains very represent-DWLYHRIKRZPRVW%UD]LOLDQSV\FKLDWULFLQVWLWXWLRQVIXQFWLRQHG1RGRXEWWKH histories of other asylums around the country remain to be told, in particular those histories from the military dictatorship years.

5. The Movement for Brazilian Psychiatric Reform

%\WKHHQGRIWKHVWKHVLWXDWLRQRI%UD]LOLDQSV\FKLDWULFLQVWLWXWLRQKDG become unsustainable. In that same context, a new generation of critical and engaged psychiatrists and psychoanalysts started to organize themselves. In HFKRLQJDEURDGLPSXOVHIRUPRUHVRFLDOPRYHPHQWSDUWLFLSDWLRQWKH 0760 0HQWDO +HDOWK:RUNHUV 0RYHPHQW ZDV IRUPHG LQ 5LR GH -DQHLUR ,QWKHVDPH\HDUWKH)LUVW%UD]LOLDQ&RQJUHVVRI3V\FKRDQDO\VLV*URXSVDQG ,QVWLWXWLRQVWRRNSODFHZLWKWKHSDUWLFLSDWLRQRI¿JXUHVVXFKDV)UDQFR%DVD-JOLD)HOL[*XDWWDUL5REHUW&DVWHO(UYLQJ*R൵PDQQDQG7KRPD]6]DV]7KH GHEDWHVDURXQGWKH6868QL¿HG+HDOWK6\VWHPDOVRVWDUWHGWRPDWXUH

The movement for psychiatric reform was driven by a systematic critique of the exclusionary and isolationist practices on which the asylum-form was based. It took as its target the very core understanding of madness and the way in which the entire system was structured on a hospital-centric model. The same movement took part in larger debates, beyond clinical issues, and was framed broadly in terms of citizenship and human rights.

7KH%UD]LOLDQ5HIRUPGUHZRQWKHLGHDOVRIWKHDQWLSV\FKLDWU\PRYHPHQW± LQSDUWLFXODUWKH,WDOLDQ±DVZHOODVIURP)UHQFKLQVWLWXWLRQDOUHIRUPV7KHVH PRYHPHQWVKRZHYHUZHUHYHU\GL൵HUHQWRQHIURPDQRWKHU7KH,WDOLDQPRYH- PHQWIRXJKWIRUWKHWRWDOGLVPDQWOHPHQWRIDV\OXPV±W\SL¿HGE\WKHH[SHUL-HQFHVRI)UDQFR%DVDJOLDLQ*RUL]LD±DQG7ULHVWHIURPDQG FXOPLQDWLQJLQWKH,WDOLDQ0HQWDO+HDOWK$FWRIWKHIDPRXV/DZ

Psychiatric Power 

The French movement, in turn, claimed the necessity of a radical transforma- WLRQRIWKHKRVSLWDOVWUXFWXUHDOWKRXJKZLWKRXWDEROLVKLQJLWVIXQFWLRQ±UHS-resented by the psychotérapie institutionnelle, the experiences taking place in 6DLQW$OEDQ +RVSLWDO GXULQJ WKH 6HFRQG:RUOG:DU DQG DW /D %RUGH &OLQLF IURP:KDWERWKPRYHPHQWVKDGLQFRPPRQZDVWKHFRQFHUQDERXW rethinking mental disorders in terms of their intrinsic social and relational dimension, the critique of the absolutely vertical doctor-patient relationship, and the importance of rethinking care in more horizontal and collective terms.

Basaglia’s proposal was certainly radical: the need to dismantle the tradi- WLRQDOSV\FKLDWULFVWUXFWXUHWKDWLVWRFORVHWKHSDYLOLRQVDQGSV\FKLDWULFLQ¿U-PDULHVLQRUGHUWRUHSODFHWKHPZLWKDVHULHVRIPRUHH൶FLHQWDQGKXPDQL]HG services, spaces, strategies, dispositives. The alternative proposed by the psy-chiatrist was the creation of local Centri di Salute Mental&60WKDWZRXOG EH WHUULWRULDOO\ EDVHG$FFRUGLQJ WR WKLV SHUVSHFWLYH WKH &60 ZRXOG DW WKH same time treat the mentally ill and work to advance the social comprehen-sion of madness, adapting society to serve as a welcoming host for the mad. According to Basaglia, the traditional therapeutic institution gave too much power to the psychiatrist, and in reality only served so that people could be UHFRQFLOHGZLWKWKHYLROHQFHWKH\VX൵HU,QRWKHUZRUGV³SV\FKLDWULFVFLHQFH´ ZDVDWRROLQWKHVHUYLFHRIGRPLQDQWSRZHUVUHÀHFWLQJZKDWVRFLHW\DWODUJH GHFLGHGWRPDNHRIWKHPHQWDOO\LOOSHUVRQ%DVDJOLD,QWKLVSHU-spective, there is no mental disorder “in itself”: it always appears inside a certain structure of relationality that gives it meaning. Furthermore, there are certainly better and worse structures for providing care, structures in which the disorder expresses itself. In that sense, the crucial issue where mental disorders are concerned, claims Basaglia, is to determine what type of relationship is HVWDEOLVKHGZLWKWKHSDWLHQWDQGWKXVZLWKWKHGLVRUGHULELG%\DVVXP-ing this position, Basaglia did not deduce that the pathology does not exist,8

but, rather, he sought to question the presupposition according to which the PHQWDOGLVRUGHUPXVWEHLVRODWHGLQRUGHUWREHWUHDWHG2QWKHFRQWUDU\E\LVR-ODWLQJWKHPHQWDOGLVRUGHURQHLQIDFWWUDQVIRUPVLWLQWRD¿FWLYHREMHFWGHYRLG of any relation to the broader, complex existence of subjects and social bodies in which it develops. And, by doing so, one only renders chronic the pathology. In that sense, Basaglia considered it a crucial task to shift the perspective “from PHQWDOGLVRUGHUVWRWKHH[LVWHQFHVX൵HULQJ´RIWKHVXEMHFWDV)UDQFR5RWHOOL %DVDJOLD¶VVXFFHVVRUSXWVLW5RWHOOL$PDUDQWH,WZDVLPSRUWDQWIRU the Italian psychiatrist, following Edmund Husserl’s gesture, to operate a sort of phenomenological reduction, suspending the idea of disorder in order to ZRUNZLWKWKHVXEMHFW¶VFRQFUHWHH[SHULHQFHUHYHDOLQJWKHVLQJXODUVX൵HULQJ subject hidden behind the nosological framework of the “pathology.”

According to Basaglia’s critique, the only possible position is to negate the institution, the asylum’s mode of operation and push for extra-hospital forms RIFDUH,QWKH¿UVWLQVWDQFHKLVWKLQNLQJFHQWHUVRQD³WKHUDSHXWLFFRPPX-nity”: _{organization of discussion groups, “operative groups” co-involving the}

 Marlon Miguel

The “therapeutic function” should be exercised by all of these actors. What LVDWVWDNHLQ%DVDJOLD¶VFULWLTXHLVKRVSLWDOV¶KLHUDUFK\±DFULWLTXHWKDWDGYR-cates for “horizontality” and the “democratization” of the therapeutic rela-tions. However merely dismantling the hospital and multiplying extra-hospital services, or use of the term “therapeutic community,” does not itself solve WKHSUREOHPDQGWKHVHSUDFWLFHVKDYHWKHLUDPELJXLWLHV%DVDJOLD, 112; 5RWHOOL$PDUDQWH; %LUPDQ&RVWD:KDWLVFUXFLDOLVWKHSHUPDQHQW GHFRQVWUXFWLRQRIDV\OXPORJLFV±ZKLFKLQWXUQPHDQVWKHSHUPDQHQWUHLQYHQ-tion of care situaGHFRQVWUXFWLRQRIDV\OXPORJLFV±ZKLFKLQWXUQPHDQVWKHSHUPDQHQWUHLQYHQ-tions.10 _{And this permanent movement does not come without}

an unending questioning of social reality and positions of power.

7KHRWKHUFUXFLDO¿JXUHEHKLQGWKH%UD]LOLDQ5HIRUPLV&DWDODQSV\FKLDWULVW )UDQoRLV7RVTXHOOHVZKRÀHG)UDQFR¶VUHJLPHGXULQJWKH6SDQLVK&LYLO:DU and began practicing a very innovative type of work at the Saint-Alban Hos-

SLWDOLQ/R]qUHVRXWKHUQ)UDQFH7KLVH[SHULHQFHSUHFHGHGWKHODWHUpsychoté-rapie institutionnelleRI-HDQ2XU\DQG)pOL[*XDWWDULLPSOHPHQWHGDWWKH/D

%RUGH &OLQLF 7RVTXHOOHV DWWHPSWHG WR GLVUXSW WKH WUDGLWLRQDO SDWLHQWGRFWRU FDUHWDNHUUHODWLRQVKLSE\LQWURGXFLQJWKHLGHDRID³WKHUDSHXWLFFROOHFWLYH´ ³WKHUDSHXWLFFOXE´DQGEUHDFKLQJWKHGLFKRWRP\EHWZHHQ³LQVLGHRXWVLGH´ that characterizes asylum spaces. His main aim was to “integrate madness at the cite,” at the same time seeking to create strategies so that the mad “suc-FHHGVLQKLVPDGQHVV´)UDQoRLV7RVTXHOOHVZLWK5HFKHUFKHVZKHQ SURYLGHG ZLWK IDYRUDEOH FRQGLWLRQV DQG DUH QRW ³VXSSUHVVHG´ réfoulés E\ society.

For Tosquelles, the psychiatric institution must break with its conventional closed-circuit, so that the mental disorder can be properly treated. In order to achieve that, it is crucial to reconnect the mentally ill patient with their social milieu and continue working after their hospitalization has concluded. 7RVTXHOOHVDQG/XFLHQ%RQQDIpFDOOHGWKLV³JHRSV\FKLDWU\´DSUDFWLFHLQZKLFK WKHSDWLHQWLVUHLQVHUWHGLQWRVRFLHW\$FFRUGLQJWR%RQQDIp6DLQW$OEDQ¶VUHDO LQQRYDWLRQ ZDV JHRSV\FKLDWU\ ± D SUDFWLFH UDUHO\ HPSKDVL]HG E\ KLVWRULDQV DQGFRPPHQWDWRUVZKRDFFRUGLQJWR%RQQDIpLQVWHDGLQVLVWRQLQWUDKRVSLWDO work. Geo-psychiatry involved work outside the hospital that would enable the patient to “disalienate” and help their “reinsertion into a human geography” LELG

While La Borde remained a psychiatric hospital, that institution’s orienta-WLRQZDVGH¿QHGE\DQRSHQQHVVWRZDUGVWKHRXWVLGHZLWKVHYHUDODFWLYLWLHV taking place within the clinic also being open to the public, and those outside available to patients. La Borde also applied the notion of “institutional analy-sis” as a decisive tool for disrupting the static forms of traditional psychiatric organization, placing particular emphasis on transversality rather than power relationships. Institutional analysis consisted of a permanent questioning of the hospital’s functioning, enabling it to be open to the constant transformation of UHODWLRQVEHWZHHQWKRVHZRUNLQJDQGOLYLQJLQWKHLQVWLWXWLRQ7KXVLQ for example, it was decided that everyone working at La Borde would earn the same salary regardless of their position. Transversality and the search for

Psychiatric Power 

KRUL]RQWDOLW\ZHUHDOVRWKHVSHFL¿FREMHFWLYHVRI³FOXEV´ZKHUHSDWLHQWVZRXOG SOD\DFWLYHUROHVOHDGLQJDFWLYLWLHVDQGZRUNVKRSV5HFKHUFKHV+HQFH while the French and the Italian contexts certainly shared similarities, Basaglia KDGDLPHGDWGLVPDQWOLQJWKHSV\FKLDWULFLQVWLWXWLRQZKHUHDV-HDQ2XU\VDZ “anti-psychiatry” as “the true psychiatry” and the “institutional utopia” capa-EOHRI³VDYLQJSV\FKLDWU\´2XU\

*XDWWDULSDLGVHYHUDOYLVLWVWR%UD]LOEHJLQQLQJLQDQGKHWRRNDVKDUS interest in the foundation of the Workers’ Party. Basaglia travelled to Brazil in DQGDJDLQLQDQG7KHFORVXUHRIWKH3V\FKLDWULF+RVSLWDOLQ 7ULVWHVLQDQGWKHDSSURYDORI/DZLQ,WDO\JDYHVSHFLDOLPSHWXVWR the Brazilian movements.

0RUHWKDQ³KXPDQL]LQJWKHDV\OXP´±ZKLFKLQDVHQVHZDVDOUHDG\3LQHO¶V PRWWR±WKH%UD]LOLDQ5HIRUPDLPHGDWDQHZVRFLDOXQGHUVWDQGLQJRIWKH¿J-ure of the mad and, in keeping with the Italian movement, sought to close the asylums. The reform intended to reframe the understanding of what was PHDQWE\³PHQWDOKHDOWK´³WRGHELRORJL]HSDWKRORJ\DQGVRFLRORJL]HVX൵HU-LQJ´Biehl 2005WRVKLIWWKHSHUVSHFWLYHIURPGLVRUGHUWRZDUGVWKHVWDWH RIVX൵HULQJDQGWKHVXEMHFW¶VFRQFUHWHH[LVWHQFH)XUWKHUPRUHLWZDVDUJXHG WKDW WKH QRWLRQV RI FDUH DQG WUHDWPHQW QHHGHG WR PRYH EH\RQG WKH ¿HOGV RI medicine and psychology. In that sense, the progressive replacement of the asylum by other dispositives was envisioned as helping the patient to recreate social ties. Indeed, one of the foundational concepts behind the Reform was “territory” or “subjective territory”: a network of social references that anchor WKHVXEMHFWLQWKHZRUOGDQGWKDWDUHHVVHQWLDOWRWKHFXUH'HOJDGR7KH Reform thus emerged as the exact opposite of the private, exclusionary, and isolationist model adopted by the military dictatorship. Against isolation and the hospital space, it proposed a notion of social, public, and territorial care that would nourish the patient’s social ties.

$QLPSRUWDQWWXUQLQJSRLQWIRUWKHPRYHPHQWZDVWKH6HFRQG&RQJUHVVRIWKH 0760KHOGLQ7KHPRYHPHQWDWWKDWWLPHEHJDQWRSHUFHLYHWKHQHFHVVLW\ of opening its ranks beyond the almost exclusive participation of mental health professionals, and include patients and families. It was in this period as well that the movement adopted its clearest slogan: Por uma sociedade sem manicômios )RUDVRFLHW\ZLWKRXWDV\OXPV7KHFUHDWLRQRIJURXSVDQGDVVRFLDWLRQVIRO-ORZHGVSUHDGLQJDFURVVWKHFRXQWU\6266D~GH0HQWDO6mR3DXOR&DEHoD )HLWD 5LR GH -DQHLUR 6WDWH /RXFRV SRU 9RFr 0LQDV *HUDLV 6WDWH /RXFRV SRU&LGDGDQLD3HUQDPEXFR6WDWH/RNRPRWLYD5LR*UDQGHGR1RUWH6WDWH 4RUSR6DQWR5LR*UDQGHGR6XO6WDWHDPRQJRWKHUVAmarante 2011

Another landmark event contributing to the Reform took place in Santos 6mR 3DXOR 6WDWH LQ  DW WKH &DVD GD 6D~GH$QFKLHWD$OVR NQRZQ DV the “House of Horrors,” this psychiatric institution was a space typical of WKH ³PDGQHVV LQGXVWU\´ DQ RYHUSRSXODWHG DQG GHUHOLFW SULYDWH LQVWLWXWLRQ ± IXQGHGE\WKHVWDWH±WKDWHPSOR\HGDEXVLYHGLVFLSOLQDU\PHWKRGVVXFKDVHOHF-troshock as means of punishment, leading to the death of patients. Telma de 6RX]DFLW\FRXQVHOORUDQGODWHUPD\RUIRUWKH:RUNHUV¶3DUW\±DOVRDSDUW\

 Marlon Miguel

FRIRXQGHU±OHGDQRFFXSDWLRQRIWKHLQVWLWXWLRQSURWHVWLQJDJDLQVWWKH&DVD¶V conditions and eventually achieving the institution’s closure. The occupation was also a way of demonstrating that the ideals of patient deinstitutionalization and the private sector’s interest in maintaining the patients hospitalized were fundamentally incompatible interests. The new therapeutic spaces to be cre-ated along with reform would thus be exclusively public.

These movements played an instrumental role in drafting the chapter on KHDOWK LQFOXGHG LQ WKH  &RQVWLWXWLRQ DV ZHOO DV WKH OHJDO LQVWLWXWLRQ RI WKH686WKURXJK/DZDQGWKHVXEVHTXHQW³VRFLDOFRQWURO ODZ´/DZZKLFKWUDQVIRUPHGORFDOFRPPXQLWLHVLQWRFHQWUDOVLWHVRI healthcare administration. Likewise, thanks to reform movement, communities became central actors in debates around mental health policy and the adminis-tration of psychosocial institutions. It was also through this law that the term “patient” was replaced by usuárioXVHUFXVWRPHURUE\³citizen burdened by PHQWDOVX൵HULQJ´HPSKDVL]LQJWKHLUDJHQF\DQGUROHDVVRFLDODFWRU ,QWKH:RUNHUV¶3DUW\GHSXW\IRU0LQDV*HUDLV3DXOR'HOJDGR±EURWKHU RIDFWLYLVWSV\FKLDWULVW3HGUR'HOJDGR±SUHVHQWHGODZSURSRVDOWKH 3V\FKLDWULF5HIRUPELOO,WVPDLQSRLQWVZHUHSXWDKDOWWRWKHFRQVWUXF-WLRQRIQHZSV\FKLDWULFKRVSLWDOVUHGLUHFWVWDWHUHVRXUFHVWRWKHFUHDWLRQRI QRQWUDGLWLRQDOSV\FKLDWULFFDUHVWUXFWXUHVPDNHLWREOLJDWRU\WKDWIRUFHG hospitalizations be reported to the corresponding legal authority, so that hospi-WDOL]DWLRQFRXOGEHOHJDOO\DSSURYHGRUGHQLHG7ZRRWKHULPSRUWDQWHOHPHQWV DUHDGGHGWRWKHSURMHFWLQWKHQRWLRQRIatenção integralLQWHJUDWHG DVVLVWDQFH DJDLQVW ³VSHFLDOL]HG DVVLVWDQFH´ ZKLFK ZRXOG SDYH WKH ZD\ WR GLYHUVL¿HGIRUPVRIFDUHDQGWKHQRWLRQRI³FLWL]HQVKLS´DVIXQGDPHQWDO where mentally ill patients’ rights are concerned. The project began implemen- WDWLRQGXULQJWKHVZLWKWKHFUHDWLRQLQSDUWLFXODURI3V\FKRVRFLDO&RP-PXQLW\ &HQWHUV &$3611_{ +RZHYHU WKH ³PHQWDO KHDOWK ODZ´ /DZ }

would only be approved, after many years of discussion and in a watered-down version, in April 2001. That law would also emphasize the assistance model, DVZHOODVWKHSURWHFWLRQDQGULJKWVRISHRSOHVX൵HULQJIURPPHQWDOGLVRUGHUV but it did not adopt one of the movement’s central demands: the progressive GLVPDQWOHPHQWRIDV\OXPV)LQDOO\/DZOHJLVODWLQJIRU the program De volta para casa%DFNKRPHHPSKDVL]HGDJDLQGHLQVWLWX-tionalization, establishing assistance for long-term hospitalized patients. Albeit slowly, and still struggling with the remnants of a derelict system, the public mental health system has grown considerably throughout the 2000s, in keeping with the new progressive agenda set during that time period.

6. De-democratization and the Dismantlement of the Mental Health System

7KHBauru Letter, a landmark for the Reform, equates “democratic soci-ety” with “a society without asylums.” The Reform movement was far from IXO¿OOLQJ DOO LWV SURPLVHV +RZHYHU IRU WKH ¿UVW WLPH VWUXFWXUDO TXHVWLRQV

Psychiatric Power 

FRQFHUQLQJPHQWDOGLVRUGHUVZHUH¿QDOO\EHLQJDGGUHVVHGDQGH൶FLHQWO\PDQ-DJHG7KH:RUOG+HDOWK2UJDQL]DWLRQIRUH[DPSOHUHFRJQL]HVWKHLPSRUWDQFH and improvement of the Brazilian mental health system after the implementa-WLRQVRIWKH5HIRUPDQGFDOOVIRUWKHSURJUDP¶VH[SDQVLRQ:+2

'HVSLWHWKHVHUHFRJQLWLRQVLQ0LFKHO7HPHULPSOHPHQWHG&RQVWLWX-WLRQDO$PHQGPHQW1XPEHUDQGODWHULQWKURXJKDVHULHVRISROLFLHV his administration began to dismantle the Reform’s achievements not only E\ FXWWLQJ IXQGLQJ WR KHDOWKFDUH ZKLFK GLG LQ IDFW WDNH SODFH EXW DOVR E\ fundamentally targeting its main principles: reducing territorial mental health structures, resuming the hospitalization strategy and investing in psychiatric hospital beds, and so on. Between that project, initiated by Temer, and the cur-UHQWDJHQGDOHGE\-DLU%ROVRQDURWKHUHKDVEHHQUHPDUNDEOHFRQWLQXLW\12 _In

WKUHH\HDUV±WKHLUVKDUHGDJHQGDPRGL¿HGWKH1DWLRQDO3URJUDP RI3ULPDU\&DUH31$%GLVSHQVLQJZLWKFRPPXQLWDULDQKHDOWKZRUNHUDVVLV-WDQFHIRUIDPLOLHVH[SDQGHGIXQGLQJIRUSV\FKLDWULFKRVSLWDOVDQGLQFUHDVHG WKHSULFHRIGDLO\KRVSLWDOL]DWLRQUHGXFHGWKHUHJLVWUDWLRQRIQHZ&$36 reasserted the role of psychiatric hospitals as the main institution responsible IRUFDUHUHHVWDEOLVKHGGD\KRVSLWDOVVWUXFWXUHVUHHVWDEOLVKHGVSHFLDO-ized and non-local outpatient services.

Bolsonaro’s agenda however has been even more aggressive, and his model IRU WKH PHQWDO KHDOWK V\VWHP LV RXWULJKW H[FOXVLRQDU\ ,Q )HEUXDU\  KH SXEOLVKHG³7HFKQLFDO1RWH1XPEHU´UHJDUGLQJWUDQVIRUPDWLRQVWRQDWLRQDO mental health policy, wherein he criticized the current “ideology” of the sys- WHPDQGSURSRVHGWRUHSODFHLWZLWK³VFLHQWL¿FPHWKRGV´EDVHGRQWKH³WHFKQL-cal knowledge” of psychiatric hospitals, biologiWHPDQGSURSRVHGWRUHSODFHLWZLWK³VFLHQWL¿FPHWKRGV´EDVHGRQWKH³WHFKQL-cal treatment methods such as electroconvulsive therapy, and the hospitalization of children and adolescents %UDVLO; 'HOJDGR7KHH൵HFWVRIWKHVHSROLFLHVDUHDOUHDG\EHLQJ felt. A new national report for 2018 and published last December, surveying SV\FKLDWULFKRVSLWDOVLQVWDWHVDFURVVWKHFRXQWU\VKRZVGUDPDWLFKXPDQ ULJKWVYLRODWLRQVDQGVLJQVRIWRUWXUHLQVLGHWKHVHLQVWLWXWLRQV%UDVLOE

Bolsonaro’s discourse is also emphatic in its attempt to revive traditional medical vocabulary as a means to pathologize his enemies. He seeks to trans- IRUP³WKHRWKHU´OHIWLVWVFRPPXQLVWVWKH/*%7SRSXODWLRQLQWRDQDEQRU-PDO ¿JXUH DQG DVVHUWV WKH QHHG WR H[FOXGH WKHP IURP YLVLEOH SXEOLF VSDFH 7\SLFDO RI DXWKRULWDULDQ UHJLPHV DOWHULW\ DXWRPDWLFDOO\ EHFRPHV D ¿JXUH RI deviation that needs to be isolated and “treated.”

+LGLQJ EHKLQG WKLV SVHXGRWHFKQRVFLHQWL¿F GLVFRXUVH LV D SURJUDP WKDW embraces a renewed exclusionary agenda very similar to what existed before WKH5HIRUP:LWKWKHVDPHFODLPVWRVFLHQWL¿FLW\DQGH൶FLHQF\XVHGWRSUR-mote private care decades ago, Bolsonaro’s program represents a clear sign of de-democratization. As in so many other aspects of the government’s agenda, WKHLQVLVWHQFHRQSULYDWHFDUHUHÀHFWVQRWRQO\WKHHFRQRPLFLQWHUHVWVRIDVPDOO group of powerful individuals, but also a project to eradicate any type of large, popular, democratic agency. Against social and collective control, against the idea of public and territorial care, nourishing the patient’s social ties, against

 Marlon Miguel

all these elements that were central to the Reform, the hospital-centric model DJDLQUHDUVLWVKHDGDORQJZLWKWKHDOOSRZHUIXOSV\FKLDWULVW±DPHUHSXSSHW DFWLQJRQEHKDOIRIDUDGLFDOO\DXWKRULWDULDQLGHRORJ\WKDWKDWHVGL൵HUHQFH Acknowledgment ,DPJUDWHIXOWRWKH)&7³)XQGDomRSDUDD&LrQFLDHD7HFQRORJLD,3´IRU WKHLU¿QDQFLDOVXSSRUW6WLPXOXVRI6FLHQWL¿F(PSOR\PHQW,QGLYLGXDO6XSSRUW &((&,1'&3&7 Notes 1. IWKDQN1LFRODV$OOHQIRUSURRIUHDGLQJP\WH[W

2. And even inside psychiatric institution employing more humane and experimental DSSURDFKHVWKHVHSUDFWLFHVZHUHWKHH[FHSWLRQ,QWKH\HDUV±IRUH[DPSOH DWWKH-XTXHU\+RVSLWDOZKHUH&pVDUZRUNHGRQO\RISDWLHQWVZRXOG WDNHSDUWLQWKH$UWV6HFWLRQ&DEDxDV

3. Foucault notes that the appearance of the psychiatric hospital in Europe and “mas- VLYHKRVSLWDOL]DWLRQV´ZHUHDOVRD³SROLFHD൵DLU´LQVSLUHGE\FRQFHUQVYHU\GLYHU-JHQWIURP³KHDOLQJ´)RXFDXOW

 In fact, colonial asylums in particular were conceived as places not only for the PDG EXW IRU DOO WKRVH EUDQGHG XQGHVLUDEOH 5RGULJXHV &DOGDV UHVSRQVLEOH IRU PRYLQJWKH-XOLDQR0RUHLUD+RVSLWDOWRWKH-DFDUHSDJXiQHLJKERUKRRGFODLPHG LQWKDW³EHVLGHVDOFRKROLFVPDGUHWDUGHGGHOLQTXHQWV´WKH$V\OXPZDVDOVR meant for “the undesired enemies of order and the public good, possessed by the red delirium, fanatics of the bloody and dangerous anarchists and communists doc-WULQHVRI0DU[LVPRU%ROVKHYLVP´5RGULJXHV&DOGDVZLWK+LGDOJR 5. Framed by a cultural and social perspective, although also impacting policies and

ideologies, the eugenicist discourse was progressively replaced by that of racial democracy, thanks to authors such as Gilberto Freyre. Freyre’s celebrated formula-tion emphasized, on the contrary, the positive aspects of Brazilian miscegenaformula-tion. Despite that, psychiatric institutions would remain a locus of sanctioned exclusion, UHÀHFWLQJWKHVRFLRHFRQRPLFVWUXFWXUHRI%UD]LOLDQVRFLHW\

 )RUH[DPSOHDIWHUYLVLWLQJWKH0XVHXPRI,PDJHVRIWKH8QFRQVFLRXVLQ Ronald Laing would recognize her work as essential to the study of psychosis.  This was the case of, among others, Paulo Amarante, who, along with two

col-OHDJXHV ZDV ¿UHG DIWHU GHQRXQFLQJ WKH FRQGLWLRQV LQ WKH DV\OXP ZKHUH WKH\ ZRUNHG$PDUDQWHRU)UDQFLVFR%DUUHWRSHUVHFXWHGE\WKH5HJLRQDO &RXQFLO RI 0HGLFLQH DIWHU ¿OLQJ D UHSRUW RQ WKH &RORQLDO +RVSLWDO RI %DUFHQD $UEH[

8. Ronald Laing takes a similar stance when he claims that mental illness should not be taken as the natural object that psychiatry takes it to be, but rather an experience of the subject in their relationship with the socius. However, his position concern-ing pathology seems much more relativistic, where the division between the “nor-PDO´DQGWKH³SDWKRORJLFDO´DSSHDUVWREHH[WUHPHO\EOXUUHGFI/DLQJ 

2QHFDQUHYLVLWWKHWHUP³SV\FKRVRFLDOPHGLFLQH´DVLWDSSHDUVLQWKH%ULWLVKFRQ-WH[WDURXQGPLGWKFHQWXU\LQ-DPHV/+DOOLGD\¶VZRUN

10. The USA, for example, saw the emergence of “deinstitutionalization” practices PHDVXUHVWDNHQWRKHOSWKHSDWLHQWVZKHQWKH\OHDYHWKHKRVSLWDODQGDFRPPXQLW\ care logic, in which the creation of mental health centers, outpatient care, clinical residences, shelters, and day-hospitals ended up contributing to the medicalization of life and even more demands from people concerning these services.

Psychiatric Power 

11. 7KH¿UVW&$36XQLWRSHQHGLQLQ6mR3DXOR6HYHUDOXQLWVZHUHDOVRFUHDWHG LQ6DQWRVDIWHUWKH&DVDGD6D~GH$QFKLHWDZDVVKXWGRZQ7KH&$36DUHORFDOWHU-ritorial, outpatient assistance structures. Their guiding inspiration was to open up the PHQWDOKHDOWKVHFWRUDQGFRQQHFWZLWKFLYLOVRFLHW\7KHUHDUH¿YHW\SHVRIVWUXFWXUHV DQGVRPHIXQFWLRQKRXUVZLWKWKHFDSDELOLW\RIWUHDWLQJVXEMHFWVGXULQJFULVHV'LI-ferent from hospitals, they are open spaces and allow the patient to be accompanied E\UHODWLYHV7KH&$36DUHDOVRHQFRXUDJHGWRFUHDWHGL൵HUHQWNLQGVRIUHODWLRQDO clinical, and expressive activities, with the aim of reducing medication and preventing hospitalization. They are open to professionals of other areas, such as artists who can organize activities there and are invited to interact with the local territory.

12. 3V\FKLDWULVW4XLULQR&RUGHLURVHUYHGDV7HPHU¶VJHQHUDOFRRUGLQDWRUIRUWKH0HQWDO +HDOWK$OFRKRODQG'UXJV6HFWLRQRIWKH0LQLVWU\RI+HDOWKDQGLVQRZ%ROVRQ- DUR¶V1DWLRQDO6HFUHWDU\RI&DUHDQG'UXJV3UHYHQWLRQLQWKH0LQLVWU\RI&LWL-zenship. He is a clear supporter of forced hospitalization and defends that mental healthcare should be separated from drugs-addiction policies transforming drugs LQWRDSULPDULO\³SROLFHD൵DLU´

References

Amarante, Paulo, ed. 2011. Saúde mental e atenção psicossocial5LRGH-DQHLUR)LRFUX] Arbex, Daniela. 2018. Holocausto Brasileiro. Genocídio: 60 mil mortos no maior

hos-pício do Brasil. São Paulo: Geração Editorial.

———. 2013. Holocausto Brasileiro. São Paulo: Geração Editorial.

%DVDJOLD)UDQFRHG³&RUSVUHJDUGHWVLOHQFH/¶pQLJPHGHODVXEMHFWLYLWpHQ psychiatrie” [Body, viewpoint, and silence: The enigma of subjectivity in psychia-WU\@L’Evolution Psychiatrique±

²²²A instituição negada: relato de um hospital psiquiátrico5LRGH-DQHLUR Edições Graal.

%LHKO-RmR*XLOKHUPHVita: Life in a Zone of Social Abandonment2DNODQG 8QLYHUVLW\RI&DOLIRUQLD3UHVV

%LUPDQ-RHO³2QHJURQRGLVFXUVRSVLTXLiWULFR´,QCativeiro e liberdade, edited by -DLPH'D6LOYD3DWUtFLD%LUPDQDQG5HJLQD:DQGHUOH\±5LRGH-DQHLUR8(5- %LUPDQ-RHODQG-XUDQGLU)UHLUH&RVWD³2UJDQL]DomRGHLQVWLWXLo}HVSDUDXPD psiquiatria comunitária.” In Psiquiatria social e reforma psiquiátrica, edited by $PDUDQWH3DXOR±5LRGH-DQHLUR)LRFUX]

%UDVLO &RQVHOKR )HGHUDO GH 3VLFRORJLD  Hospitais Psiquiátricos no Brasil:

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org.br/publicacao/hospitais-psiquiatricos-no-brasil-relatorio-de-inspecao-nacional/. %UDVLO 0LQLVWpULR GD 6D~GH  ³1RWD7pFQLFD (VFODUHFLPHQWRV VREUH DV

PXGDQ-oDV QD 3ROtWLFD 1DFLRQDO GH 6D~GH 0HQWDO H QDV 'LUHWUL]HV QD 3ROtWLFD 1DFLRQDO VREUH 'URJDV´ &RRUGHQDomR 1DFLRQDO GH 6D~GH 0HQWDO ÈOFRRO H 2XWUDV 'URJDV 1RYHPEHU$YDLODEOHDWZZZDEUDVFRRUJEUVLWHZSFRQWHQWXSORDGV BBBB1RWDB7H&&FQLFDBQRBB(VFODUHFLPHQWRVBVREUHBDVB PXGDQF&&$DVBGDB3ROLWLFDBGHB6DX&&GHB0HQWDOSGI.

&DEDxDV.DLUD0DULHLearning from Madness: Brazilian Modernism and Global

Contemporary Art&KLFDJR7KH8QLYHUVLW\RI&KLFDJR3UHVV

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Saúde Mental: a ética de cuidar5LRGH-DQHLUR6HFUHWDULD0XQLFLSDOGH6D~GH9,

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saúde   5LR GH -DQHLUR (SXE$YDLODEOH DW KWWSG[GRLRUJ

VRO.

)RXFDXOW0LFKHO+LVWRLUHGHODIROLHjO¶kJHFODVVLTXH. Paris: Gallimard. *R൵PDQ(UYLQJAsylums. Essays on the Social Situation of Mental Patients and

other Inmates1HZ<RUN$QFKRU%RRNV

Hidalgo, Luciana. 2011. Arthur Bispo do Rosário. O senhor do labirinto5LRGH-DQHLUR Rocco.

,%*(,QVWLWXWR%UDVLOHLURGH*HRJUD¿DH(VWDWtVWLFDVEstatísticas do século XX. /DLQJ5RQDOG'DYLGThe Politics of Experience and The Bird of

Paradise0LG-dlesex: Penguin.

0DFKLQ5RVDQDDQG$QGUp0RWD³(QWUHRSDUWLFXODUHRJHUDODFRQVWLWXLomR GHXPDµORXFXUDQHJUD¶QR+RVStFLRGH-XTXHU\HP6mR3DXOR%UDVLO±±´ In Interface. Comunicação, saúde, educação9RO%RWXFDWX$YDLODEOHDW KWWSG[GRLRUJLQWHUIDFH.

0HOOR &DUORV *HQWLOH  Saúde e assistência médica no Brasil 5LR GH -DQHLUR &(%(6

0HOOR/XL]&DUORVNise da Silveira: caminhos de uma psiquiatra rebelde. Rio de -DQLHUR$XWRPDWLFD(GLo}HV/WGD5LRGH-DQHLUR+yORV&RQVXOWRUHV$VVRFLDGRV 0RWWD 5RGULJR 3DWWR 6i  ³(P *XDUGD &RQWUD R 3HULJR 9HUPHOKR

R$QWLFR-PXQLVPRQR±´'RFWRUDOGLVVHUWDWLRQ8QLYHUVLGDGHGH6mR3DXOR 2GD$QD0DULD*DOGLQL5DLPXQGR³$OLHQDomRPHQWDOHUDoDDSVLFRSDWRORJLD FRPSDUDGDGRVQHJURVHPHVWLoRVEUDVLOHLURVQDREUDGH5DLPXQGR1LQD5RGULJXHV´ 'RFWRUDOGLVVHUWDWLRQ8QLYHUVLGDGHGH&DPSLQDV$YDLODEOHDWhttp://repositorio.uni FDPSEUMVSXLKDQGOH5(326,3. 2XU\-HDQ³8WRSLHDWRSLHHWHXWRSLH´,QRevue Chimères6SULQJ±6XPPHU

Les arts de l’éco.

3DXOLQ/XL])HUQDQGRDQG(JEHUWR5LEHLUR7XUDWR³$QWHFHGHQWHVGDUHIRUPD SVLTXLiWULFDQR%UDVLODVFRQWUDGLo}HVGRVDQRV´História, Ciências, Saúde 0D\±$XJXVW±5LRGH-DQHLUR)XQGDomR2VZDOGR&UX]$YDLODEOH at: KWWSG[GRLRUJ6.

3HGURVD0DULRArte, forma e personalidade: 3 estudos6mR3DXOR.DLUyV 3RUGHXV9LWRUZLWK+HULWDJH3DXO³µ0DGQHVV\HWWKHUH¶VPHWKRGLQLW¶7KH

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Shadow of the Parent. Mythology, History, Politics and Art HGLWHG E\ -RQDWKDQ

Burke. London: Routledge.

5HFKHUFKHV  -RXUQDO  Histoire de la psychiatrie de secteur ou le secteur

impossible0DUFK&(5),

5HFKHUFKHV-RXUQDOHistoires de La Borde. L’organisation du travail à la

clinique de Cour-Cheverny (1953–1963)0DUFK±$SULO&(5),

5HLV -RVp 5REHUWR )UDQFR  ³+LJLHQH PHQWDOH HXJHQLDR SURMHWR GH µUHJHQHU-DomR QDFLRQDO¶ GD /LJD %UDVLOHLUD GH +LJLHQH 0HQWDO ±´ 0DVWHU WKHVLV 8QLYHUVLGDGHGH&DPSLQDV$YDLODEOHDWhttp://repositorio.unicamp.br/jspui/handle/ 5(326,3.

Psychiatric Power 

5HVHQGH+HLWRU³3ROtWLFDGHVD~GHPHQWDOQR%UDVLOXPDYLVmRKLVWyULFD´,Q

Cidadania e loucura: políticas de saúde mental no Brasil, edited by Benilton Bezerra

-~QLRU6LOYpULR$OPHLUD7XQGLVDQG1LOVRQGR5RViULR&RVWD3HWUySROLV9R]HV

5RWHOOL)UDQFRDQG$PDUDQWH3DXOR³5HIRUPDVSVLTXLiWULFDVQD,WiOLDHQR%UD-sil: aspectos históricos e metodológicos.” In Psiquiatria sem hospício. Contribuições

ao estudo da reforma

psiquiátricaHGLWHGE\%HQLOWRQ%H]HUUD-UDQG3DXOR$PD-UDQWH±6mR3DXOR5HOXPH'XPDUi

5R[R+HQULTXHGH%%³3HUWXUEDo}HVPHQWDLVQRVQHJURVGR%UDVLO´Brazil

Médico±±

6WHSDQ1DQF\/H\V³(XJHQLDQR%UDVLO±´,QCuidar, controlar, curar

ensaios históricos sobre saúde e doença na América Latina e CaribeHGLWHGE\&DULEH

*LOEHUWR+RFKPDQDQG'LHJR$UPXV±5LRGH-DQHLUR(GLWRUD),2&58= :+2:RUOG+HDOWK2UJDQL]DWLRQ³$5HSRUWRIWKH$VVHVVPHQWRIWKH0HQWDO

+HDOWK6\VWHPLQ%UD]LOXVLQJWKH:RUOG+HDOWK2UJDQL]DWLRQ±$VVHVVPHQW,QVWUX-PHQW IRU 0HQWDO +HDOWK 6\VWHPV :+2$,06´ :+2 DQG 0LQLVWU\ RI +HDOWK Brasília, Brazil. Available at: www.who.int/mental_health/evidence/who_aims_ report_brazil.pdf.