Reasoning Against Madness: Psychiatry and the State in Rio de Janeiro, 1830–1944 by Manuella Meyer (review)

The local history of health has been of interest to Brazilianists for decades. However, Manuella Meyer's book is the first on the history of psychiatry in Brazil to be published in English. In this sense it is a critically important work as it catapults the subject into the broader field of Latin American studies accessible to the Anglo-Saxon world. Reasoning Against Madness presents the reader with a dense interpretation of the history of psychiatry in Rio de Janeiro. The city was Brazil's capital at the time, and the National Hospital was a significant contributor to the circulation of knowledge and establishment of scientific networks, disseminating its models of mental health care to the whole country.¹

The timeline covers from the first medical debates on the importance of building an asylum for the alienated in the 1830s and the foundation of the institution in 1852 to its closing in 1944. The period comprises the whole local institutionalizing process of psychiatry as an assistance practice; the emergence of the chair of psychiatry at the Faculty of Medicine of Rio de Janeiro, as its theoretical trends, including debates on degeneration; the foundation of the Brazilian League of Mental Hygiene; and the expansion of preventive discourses. It therefore covers a crucial period in the history of local psychiatry.

Meyer's book is based on a considerable legacy of critical scholarship made in Brazil. The historian references this tradition in her book, however only in footnotes. As the author claims, "It has been considered at all by historians in Brazil, mental illness has been treated in relation to or as a variation on the state's concern with maintaining social order." Thus, "the mad have been of concern to authorities only because of the threat they posed to social order." Meyer argues then that her "study takes a slightly different perspective, focusing 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).

In fact, from the late 1970s local narratives about the history of psychiatry have often been permeated by mental health politics. As a result, this historiography was often framed in terms of social control and disciplinarity; Costa's seminal text is an example of this trend.² However, from the 1990s, with the growing professionalization of the local history of sciences, historiography started addressing practices and actors, and investigating circulation, appropriation, and negotiation of psychiatric knowledge in local society. In this new line of inquiry, the theoretical-methodological contributions also included criticism of Marxist- and Foucauldianbased social historiography. Gonçalves and Edler's work emphasizes this turn.³

Part of this new bibliography may be unknown to Meyer. However, the scholars cited in the book as secondary sources are already in dialogue with the historian's research problems. Let me illustrate: When Meyer calls attention to the start of local psychiatric practice as part of society's modernizing project, she engages a perspective already adopted by several Brazilian authors. When dealing with the disputes between different powers (church, legislative bodies and psychiatry), and even disputes within different scientific groups, the author dialogues with works that have already emphasized these tensions. Another important problem raised in her work, the struggle of mental health care providers to be protagonists for social change, has also been examined by many authors.⁴

As regards to psychiatry and spiritism, the author follows a tradition that opposes the official and popular forms of health care. As a result, the reader misses a more contextualized understanding of the forces at play: in fact, spiritism has not always been in conflict with psychiatry, especially if one considers the French Kardecism. Despite the medical defense of the secularization of customs and the argument that religion...