Mental Health as Public Health in Rio de Janeiro, Brazil

In Brazil, the national public health apparatus became one of the most agile and expansive regulatory mechanisms of control and care during the 19th and early 20th centuries. As Brazilian doctors and social thinkers made public health central to their ideas of modernizing the nation, they simultaneously sought to challenge the notion that Brazil’s sociocultural and racial-ethnic diversity was an insurmountable obstacle to modernization. They conceived of public health as something greater than the sum of its parts, seeing it is as the best prescription for national unity and fundamental to the project of nation-building, not only as a series of practices, outcomes, and beliefs. Proto-psychiatrists, recognizing the ideological momentum and bureaucratic strength of public health, seized upon it as a means and a rationale to ground their therapeutic ideas and treatments. Their characterization of the indigent mentally ill on city streets in Rio de Janeiro as a public health issue politicized both the mentally ill and mental illness as subjects of public intervention. Fashioning themselves as the leading experts in this effort, they garnered the support of state officials and other doctors to create a series of public institutions, organizations, and other measures to treat the mentally ill as unitary intersections of psychiatry and public health. While Brazilian psychiatrists during the late 19th and 20th centuries surely went into private practice, professional psychiatry in Rio as a field turned toward returning irrational minds to reason and “civilizing” the publicly unwell—dual and deeply complex goals of the profession. Public health offered them a preexisting muscular infrastructure through which to practice their medical knowledge and, in so doing, allowed them to expand and legitimize their professional reach. So, under the auspices of an enterprising psychiatric field, mental health largely became public health.