This book is a welcome addition to the historiography of psychiatry and psychiatric institutions in Latin America. Although still a relatively young and small field, the history of psychiatry is an important sub-field in the ever-expanding scholarship on the history of medicine and public health in the region. We now have good studies of the history of psychiatric ideas and practice, as well as psychiatric institutions, for several countries, most notably Mexico (see the work of Cristina Sacristán, Cristina Rivera Garza and Andrés Ríos Molina), Argentina (Mariano Plotkin, Jonathan Ablard and Hugo Vezzetti, among others), Peru (Augusto Ruiz Zevallos, Santiago Stucchi-Portocarrero and William Stein), Chile (Maria José Correa and Pablo Camus), Bolivia (Ann Zulawski) and Cuba (Jennifer Lambe). In Brazil, the largest and most populous country in the region and arguably the country with the most advanced scholarship in the history of medicine and public health, Magali Engel, Ana Teresa Venancio and Cristiana Facchinetti, among others, have made key contributions to our understanding of the emergence and development of psychiatry. This book, which draws on a commendably broad range of sources, from newspapers to medical journals, to travellers’ accounts, builds on the work of these scholars while adding valuable new insight.
In some ways, the story Meyer tells is a familiar one of experts, in this case psychiatrists, attempting to shape society and improve it. Meyer explores the emergence of psychiatry in nineteenth- and twentieth-century Brazil in the context of broader processes of modernisation and state formation in a similar way to much of the historiography on medicalisation and public health in Latin America. But what is most striking is how difficult this proved. This is not a history of ‘psychiatric power’: quite the contrary. As chapter after chapter shows, the authority of psychiatry, which for the most part had the support of the authorities, whether in the form of Emperor Pedro II in the nineteenth century or republican governments in the twentieth century, was constantly challenged: by the Daughters of Charity and the Santa Casa lay brotherhood, who had their own ideas about how to run the Rio asylum set up in 1852; by republican politicians at the turn of the twentieth century concerned about the cost and effectiveness of psychiatric care offered at the asylum; and by Kardecist spiritism and candomblé, which provided alternative and much more popular understandings of the mysteries of the mind that undermined efforts by psychiatrists to take mental hygiene out to the population at large through clinics and education campaigns. Psychiatrists in Brazil had to learn to negotiate a political and cultural environment that appears to have been more challenging than in most other countries. Indeed, the book ends with a rather unexplored argument that under the regime of Getúlio Vargas, in the 1930s and 1940s, psychiatrists became relegated to a secondary role ‘giving way to the state to facilitate and manage mental health care directly’ (p. 176).
It is not possible in a short review to address all the themes that the book covers. One of the most interesting themes, which runs throughout the book, is race; unsurprisingly given the country studied. The book offers useful insight into the interplay of psychiatric knowledge and practices and the racial hierarchies that constituted Brazilian society. Race, and, more specifically, the enslavement of Africans, Meyer shows in Chapter 1, shaped calls for the creation of a modern asylum in a context, following the abolition of the slave trade, when slaves came to be seen as ‘less replaceable and therefore more worth repairing’ (p. 32). Race also explains the disproportionate presence of white males in the asylum between 1888 and 1944: a consequence of the fact that ‘Afro-Brazilians were frequently criminalized while whites were medicalized’ (p. 74). Race also accounts, as Chapter 3 shows, for the composition of the nursing staff at the asylum (they were brought from France or chosen among white immigrants) or the fact that while white patients tended to be retained in the asylum in Rio, Afro-Brazilians were sent to agricultural colonies, annexes to the Rio asylum, where labour was intended to function as therapy. Race was also central to how the recasting of psychiatric knowledge by Brazilian psychiatrists in the early twentieth century overlapped with shifting racial thinking in Brazil, serving to challenge degeneration theory and instead celebrate miscegenation, as examined in Chapter 5. Finally, race also helps to explain why psychiatrists who targeted spiritism as psychopathy, as explored in Chapter 6, focused their efforts on Afro-Brazilian candomblé rather than on typically white Kardecist spiritists.
Meyer readily admits that she has chosen ‘not to showcase the perspectives and experiences of the mentally ill’ (p. 4). Hers is a study that ‘focuses less on the role of the insane and more on the role that psychiatrists played in structuring relationships between themselves, patients, the public, and the state’ (p. 4). Chapter 3 does provide some information on patients at the Rio asylum, but I would have liked to learn more about who these ‘madmen’ and ‘madwomen’ were to better understand the relationships that form the focus of the book. Similarly, of the two key terms in the book’s subtitle, psychiatry is given the most attention by far. The state by contrast is somewhat under-theorised or, to be more precise, the theory of the state underpinning the analysis is unstable. In the introduction, Foucauldian governmentality is evoked to account for the reforms aimed at public health which provided the framework for the emergence of psychiatry in Brazil. In Chapter 2, Bourdieu and his concept of fields provide a framework for thinking about the state. In Chapter 4 it is Michael Mann and infrastructural power. These approaches to the study of the state are not necessarily incompatible. But, in the book, they are not really put to the work that they are able to do: often the state is discussed in narrow Weberian terms as a bureaucracy existing outside, indeed in opposition to, society. Consequently, rather less is said about the interplay of psychiatry and the state than is suggested by the title.
Despite these reservations, there is little doubt that this book is a significant contribution to the history of psychiatry in Brazil, and in Latin America more generally, and should be read both by historians of Latin America with an interest in the history of medicine and public health and by historians of psychiatry who focus on other parts on the world and who have an interest in comparative perspectives.