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Nise da Silveira (1905–1999), Brazilian psychiatrist and pioneer of rehabilitation psychiatry – extra

Published online by Cambridge University Press:  02 January 2018

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Copyright © Royal College of Psychiatrists, 2016 

‘To navigate against the current, these rare qualities are needed: a spirit of adventure, courage, perseverance and passion’

– Nise da Silveira

In a time when lobotomies, electroshock and insulin therapies were still the norm in Brazilian psychiatry, Nise da Silveira stood out as a singular voice advocating for a kinder and more relational approach to the treatment of people with mental health conditions. Despite working in an arena dominated by men, she fought passionately against the status quo and was instrumental in establishing occupational therapies as a valid treatment in schizophrenia and other chronic psychiatric conditions in Brazil, changing the way in which rehabilitation was viewed and practised in her native land.

Ever the revolutionary, da Silveira found inspiration in many counter-cultural ideas and ways of thinking, both in the field of psychiatry and outside of it. In 1934, she was imprisoned for 18 months for possessing ‘subversive’ Marxist literature, having been denounced to the Vargas dictatorship by a nurse with whom she worked. Upon her return to psychiatric practice, da Silveira became increasingly disillusioned with the application of what she saw as aggressive and inhumane treatments in mental health. Inspired by the work of R.D. Laing, David Cooper and Maxwell Jones, she set out to develop new and more compassionate ways of working with those suffering with chronic illness. This led to her establishing the Seção de Terapêutica Ocupacional e Rehabilitação (Department of Occupational Therapy and Rehabilitation) in the Centro Psiquiátrico de Pedro II, Rio de Janeiro, in 1946. Here, she organised workshops for painting and sculpting where patients were encouraged to experiment with new means of emotional expression. A devotee of Carl Gustav Jung, da Silveira applied Jungian ideas to the interpretation of her patients' works in an attempt to develop a deeper and more personal understanding of the individuals in her care and the psychotic processes underpinning their symptoms. The success of this approach was evident early on and many of da Silveira's patients were able to successfully reintegrate back into society.

The works of these patients eventually came to be celebrated in the Museu de Imagens do Inconsciente (Museum of Images of the Unconscious) which da Silveira founded in 1952. The museum has remained in operation to this day and now holds over 350 000 works by patients from the 1940s to today.

da Silveira went on to establish the Casa das Palmeiras in 1956, a clinic devoted to the rehabilitation of former patients of psychiatric hospitals which eschewed the institutionalisation and restriction of liberty of its attendees. She pioneered research into the therapeutic potential of animals in recovery, naming them her ‘co-therapists’, and her work inspired the creation of cultural centres and therapeutic institutions both in Brazil and abroad. She died at the age of 94, leaving behind a truly unique legacy. Her passion and devotion to the value of emotional connection, creativity and compassion are reminders of the importance of these qualities in both the treatment and rehabilitation of people with mental illness.

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