Introduction
Natanael was a teacher and the owner of a school, but he was also a homosexual.Footnote 1 Dolores was a housewife and mother of three, but she read literature on women’s rights and wanted to sing tangos on a radio programme. Marília was also a housewife and mother of two, but she had left her husband to live in the capital with an older man, whom she ended up killing. Luísa, also named as a housewife, and Lúcio, a shopkeeper, became involved – in different ways – in an armed conflict that raged in São Paulo in 1932. Manuel, a well-known pharmacist in his town, shot the local parish priest because he believed he had seduced his wife. Valentina, another woman mentioned as a housewife in her psychiatric records, but noted as a society lady, no longer wished to live with her violent husband, who, in reaction, requested her civil ban.Footnote 2 All the people mentioned were interned at the Pinel Sanatorium between 1929 and 1944.
These people were identified by various social markers of difference, in addition to the ones I have highlighted when briefly describing them. These classificatory categories (gender, sexuality, occupation/profession, social class, age, race, ethnicity, etc.), ‘understood as local, historical and cultural constructions’Footnote 3 and articulated in a specific or generic way for each subject, show how differences ‘can contain implications in terms of hierarchy, asymmetry, discrimination and inequality’.Footnote 4 In this sense, emotion is another important marker in classifying these bodies. Emotion is found ‘in words, experiences, virtues and vices’, which ‘often appear in groups and sequences’Footnote 5 as we read, for example, in the psychiatric report about Lúcio – ‘nervous, impressionable; with an unstable mood, he went from joy to sadness for no justifiable reason’Footnote 6 – or in the letter written by Luísa, attached to her medical record – ‘I realised, however, that I could not (…) suffer in silence, that my dignity could not withstand these affronts, that my love as a woman could not withstand the shock of return and would succumb.’Footnote 7
Around 4,500 people were admitted to the Pinel Sanatorium between the time it was founded in 1929 as a private hospital and the time it was bought by the São Paulo state government in 1944, which transformed it into a public hospital.Footnote 8 Natanael, Marília, Luísa, Lúcio, Dolores, Manuel, and Valentina are part of a group of just 30 people whose writings have been located in their psychiatric records.Footnote 9 These writings, as was usual in many psychiatric institutions, were retained in their psychiatric records as documents that could contribute, through the description of acts, behaviours, disorders, disturbances, suffering, emotions, etc., in the medical assessment of what was happening to them and, above all, in assigning a diagnosis.Footnote 10
The Pinel Sanatorium was the brainchild of Dr Antonio Carlos Pacheco e Silva – an exponent of psychiatry in São Paulo and Brazil at the time – and its propaganda attested to the fact that it followed the most advanced precepts of medical science, with innovative treatments.Footnote 11 Aimed at wealthier social groups – members of the agrarian, commercial, or industrial elites – and segments of the middle classes who could afford the cost of hospitalisation, the institution was built on the outskirts of the state capital of São Paulo, in the area of the current district of Pirituba. Inspired by North American hospitals, it had 18 pavilions.Footnote 12
The very name ‘sanatorium’, instead of psychiatric hospital, already sought to differentiate that place from other similar ones aimed at the hospitalisation, treatment and, perhaps, cure – within what was understood as this at that time and place – of mad people. The latter name, even in those days, referred to overcrowding, ineffective treatment and a lack of many things – staff (mainly doctors and nurses), modern instruments to apply modern therapies, etc. – while the former referred to a social imaginary of sanatoriums as places away from the hustle and bustle of the cities, quiet, wooded, where someone could escape from the hardships of everyday life, through rest, the peace provided by immersion in nature, and still be treated with the most modern therapies, by well-trained doctors and other specialised staff, as the institutional propaganda would have you believe.Footnote 13
As the term ‘private’ indicates, the benefits of a sanatorium of this type were certainly not available to everyone, but only to those who could afford the cost of hospitalisation. At Pinel, the daily rates covered accommodation, food, nursing services, and medical care, but they did not include possible treatments – such as insulin therapy, malaria therapy, and Cardiazol therapy – tests, such as urine tests or the Wassermann reaction, or even laundry, all of which were charged for separately.Footnote 14
Many studies have been carried out on the Pinel Sanatorium, its daily life, therapeutic practices, its founder, and its inmates from different perspectives situated in the historiographical field. Many works focus on the scientific and political career of the psychiatrist Antonio Carlos Pacheco e Silva, taking Pinel as one of the loci of his action and contrasting his practices with his work as director of the Juquery Hospital.Footnote 15
A significant portion of the studies focus on analysing the women admitted to the sanatorium, problematising, from their psychiatric records, above all, the medical discourse about them and related issues. Among these issues, the ‘socio-normative aspects that characterised the female gender and that were defended as criteria of normality’ stand out, as well as the ‘reasons’ that justified the exclusion of some women from social life, classifying them as ‘deviant’. These studies look at the specificities of this classification and its relationship with themes such as ‘morality, sexuality, desires for freedom, taste for work, among others’.Footnote 16 The significant research on this theme is undoubtedly related to the growth of studies on the history of women and gender relations in Brazilian universities, especially in the 1990s and 2000s. In addition, part of this interest is based on an initial historiographical confusion: the mistaken idea that the Pinel Sanatorium was an institution exclusively for women, which only became a reality after being sold to the state government in 1944.Footnote 17
Some works focus on groups of inmates at the Pinel Sanatorium, based on social markers of difference such as age, generation, nationality, or ethnicity;Footnote 18 in others, the central objective is to discuss the mental hygiene and eugenics movement, whose main herald in São Paulo was the psychiatrist Pacheco e Silva.Footnote 19 Others use the sources produced at the hospital, especially the medical records, to discuss issues relating to the social history of language.Footnote 20
The scholarship cited above, along with other related works, made a specific and significant contribution to the field of the history of madness and psychiatry, as well as enriching more general studies on the history of medicine. This contribution was made by taking as its object of study an institution built at a time when the hygiene movement, eugenics, and biological therapies were spreading, in a context in which psychiatry was undergoing profound transformations. In addition, the research highlighted the role of a doctor who became an internationally recognised psychiatric authority and the importance of the city where the institution was located, which would become the first Brazilian metropolis. In this way, these studies have deepened our understanding of the institutional dynamics, medical practices, and social relations that marked psychiatric activity in that period.
Despite incorporating sources such as psychiatric records, studies on the Pinel Sanatorium have hitherto had a fundamental shortcoming: they have not shifted the place of enunciation by neglecting the narratives of the inmates: those that express what Roy Porter called the ‘patient’s point of view’.Footnote 21 These narratives are mostly only accessible through the filter of medical reports and, more rarely, appear in direct records, such as handwritten texts, recorded speeches, or artistic expressions, including drawings and paintings on the walls of the institutions. Although some works mention specific excerpts from these narratives, they tend to favour discussion from a medical or institutional perspective. Even when they problematise this perspective – criticising its excesses, the model of care and its limitations – they end up silencing the subjective experience of people considered mad, their perceptions of what they experienced, their emotions, and their forms of expression.
In recent decades, historiographical studies on madness and psychiatry have consolidated the narratives of people considered mad as legitimate and reliable sources.Footnote 22 Using these sources has enabled innovative interpretative approaches within the fieldFootnote 23 and offered new perspectives for understanding madness and psychiatric intervention practices in general medicine and psychiatry itself.Footnote 24
However, studies on the Pinel Sanatorium still lack an analysis that considers the inmates’ ‘point of view’ as a central perspective in constructing the institution’s history. By shifting the place of enunciation, an analytical and interpretative turn becomes possible, broadening the understanding of this history. In this work, I follow the approach inaugurated by Roy Porter, which I have explored for some time. I argue that problematising the ‘patient’s point of view’ contributes to a more refined understanding of the relationships established in the microcosm of a psychiatric institution, as well as the broader socio-cultural context that determines which individuals become susceptible to psychiatric hospitalisation.
Incorporating the narratives of people considered mad as sources and objects of analysis makes it possible to highlight both the contrasts and the similarities between those who have the authority to judge the sanity of others (such as doctors and family members) and those who occupy the position of patients. It also makes it possible to understand the effects of medical practices, the forms of resistance to them, and the patients’ subjectivity beyond their instrumentalisation in medical expertise.
Another possibility this type of source opens up is to discuss how the emotional device operates within the institution. This is the ‘set of discursive strategies – scientific, religious, legal and moral, institutional and aesthetic — that each historical era constructs and collaborates to generate, obtaining a different emotional capital for each sex’.Footnote 25 Similarly, it is possible to analyse the emotional resistance to norms, as well as the negotiations between the mad, their doctors, and families, broadening the understanding of subjective experiences in the psychiatric context.Footnote 26
Studies that analyse emotions highlight their fundamental role in the medical understanding of various illnesses, including mental illnesses. According to Alberti, historians are growing aware that medical diagnoses are culturally situated. Thus, the emergence of specific clinically recognised emotional pathologies – such as hysteria, hypochondria and neurasthenia – should not only be seen as the result of changes in emotional experience, but as a social, political and cultural construction, reflecting, above all, gender and class dynamics. As the author points out, the extent to which emotions can and should be controlled, recognised, denied, or revealed has been central to debates about health and illness from the Middle Ages to the present day. These debates, far from being merely theoretical, have been incorporated into everyday life, influencing the structure of social relations and the production of medical knowledge.Footnote 27
In the light of these considerations, the first objective of this article was to analyse how the emotions expressed by inpatients, as well as those reported by people with emotional ties to them, recorded both in psychiatric records (such as the Psychiatric Examination) and inpatients’ manuscripts, were assimilated by psychiatrists and used to formulate diagnoses, define treatments, and predict prognoses. In addition, I seek to understand how the social markers of difference were articulated to the emotional device in force in that historical context, influencing the construction of the medical perception of these emotions.
The second objective of this article was firstly to identify which emotions related to these people’s experiences were recorded in their manuscripts and then try to understand the meanings that these emotions took on for them – in other words, how they highlighted their experiences and subjectivities and functioned as tactics of resistance and negotiation.
I understand emotions as historically situated events, integrated into culture, social interactions, and intersubjective processes over time, and not limited only to the psycho-physiological dimension of the human being.Footnote 28 Emotional expressions – like bodily expressions – are signs of illness whose manifestation varies according to context, content, and form. Socially constructed and culturally regulated, these expressions fulfil a social function by guiding human action and acting as elements of identity and belonging to a group.Footnote 29
From this perspective, I look for expressions and terms in the letters analysed that reveal the emotions experienced in and through the experience of hospitalisation. Although their meanings change over time, these words are expressed and understood in particular ways in the specific context studied. It is fundamental to analyse emotions within the context in which they circulate and produce effects since they are intrinsically related to the values, objectives, and situations that subjects mobilise to make sense of the world and themselves.Footnote 30
Finally, it is noteworthy that the 30 psychiatric records from the Pinel Sanatorium containing manuscripts produced by inmates represent a small fraction of the approximately 4,500 admissions recorded during the period. These records also relate to a specific segment of the population that commonly occupies psychiatric hospitals, which therefore does not allow for generalisations about all inmates in institutions of this type. However, they constitute unique sources, whose relevance lies in providing access to the experiences and subjectivities of subjects subjected to the psychiatric regime. The choice of a restricted documentary corpus is supported by widely consolidated historiographical references, which value the thorough analysis of scarce or fragmentary sources, especially when they have high heuristic potential, as is the case with the documents in question. Both nationally and internationally,Footnote 31 the literature emphasises that, given the rarity of this type of material, the exhaustive analysis of available records is not only methodologically legitimate but also indispensable. In this study, such an approach allows us to reconstruct individual experiences, infer collective constructions, shed light on institutional practices, decipher medical and social discourses on madness, and recognise the tactics of resistance and negotiation of inmates in the face of institutional norms, by articulating social markers of difference (such as class, gender, and sexuality) with the emotional apparatus prevailing in that society during that historical period. Thus, the results presented should be understood in the light of these limitations, prioritising, however, the qualitative and interpretive potential of the testimonies for understanding experiences and practices in the context of private mental health care during the period analysed.
Given the above, the article is divided into two sections, besides this presentation and the final considerations. In the first section, I problematise the information about the people who wrote letters and other texts, contained in clinical histories written by psychiatrists. In these sources, which allow us to get to know the daily life of the institution as a whole and the particular issues related to each inpatient, I try to address the first objective that makes up the problematic of this article, that is, how the emotions of the inpatients were read and operationalised by the medical group, in the composition of a diagnosis, in the indication of treatments and in the prognostic perception of what was happening. In the second section, I try to answer the second objective by reflecting on the emotions related to the experiences (past and present) of the inpatients, expressed in the movement of their writing, and how these somehow constructed these subjects. Articulating the social markers of difference with emotions is transversal in the quest to elucidate the problem defined by the two objectives.
The work of normal and abnormal emotions from a medical perspective
Various authors have problematised the use of psychiatric records, which contain patients’ clinical histories, as sources for historical and social studies. At the same time as they are understood as paradoxical narratives, ‘in a permanent tension between the poles of order and disorder’,Footnote 32 these documents are considered reliable for investigating the daily life of institutions, within which, among other things, psychiatric practices are established that do not always coincide with the prevailing theories.Footnote 33
Since Roy Porter’s influential work, they are also recognised as a meeting place between doctors and their patients,Footnote 34 as well as sources that make it possible to access the latter’s experience.Footnote 35 It cannot be ignored, however, that when the accounts of the inpatients are recorded in the psychiatric records – including those written in their hand, often retained for this reason – they end up being subordinated to the format imposed by these documents. They thus constitute ‘part of a narrative that aims to demonstrate, or not, the condition of madness’Footnote 36 attributed to someone.
On the other hand, these true ‘discursive maps in which different voices converge’, as much as they are constituted as a hierarchical emotional device, where the voices of experts and family members have a higher status than the voices of the patients’,Footnote 37 do not fail to make it possible – through the accounts of the life problems of those considered mad – to approach, rescue and broaden the understanding of ‘practices of emotional resistance of those who, on the map drawn by power, occupy the place of subalternity’.Footnote 38
The psychiatric records at the Pinel Sanatorium consist of a few printed sheets (front and back) with fields to be filled in. The first sheet has spaces for identification data (name, age, ethnicity, marital status, profession, residence, origin), entry and exit dates, and the ‘History – Hereditary Background – Personal Background’ field. On the following pages, on both sides, there are spaces for information on the physical and mental examinations on entry (with date, time and ‘carers’ present); an indication of the ‘Persons authorised to visit the patient’; the ‘Somatic Examination’; the ‘Neurological Examination’; the ‘Psychiatric Examination’; and, finally, the ‘Diagnosis’ and ‘Course’.
Other printed sheets are present in most of them, such as prescriptions, control sheets for the application of biological therapies, and the questionnaire to be filled in by the carer at the time of hospitalisation. There are also some annexes such as laboratory tests (usually urine, faeces, blood, and the Wassermann reaction), telegrams from the institution’s directors or doctors to those in charge, letters and other writings from inmates that were not sent, as well as some letters received from family members.
All the documents that make up the corpus of psychiatric records – similar to those found in other Brazilian and foreign institutions in the same period – played a central role in the psychiatric assessment of the inmates. Among them, the questionnaire stands out, described as a complement to clinical observation, which, together with the others, provided evidence, clues, and signs considered fundamental to establishing the truth about each individual’s madness.
From the perspective of organicist psychiatry, the clinical observations made during hospitalisation, together with laboratory tests, should form the basis of the diagnosis, guide the treatments and determine the length of the patient’s stay, as well as the possibility of discharge, whether in the short or long term.Footnote 39 An analysis of the psychiatric records, especially the entries under the heading ‘Psychiatric Examination’, reveals this was not the case. The medical reports often repeated information and opinions provided by the informants in the questionnaires, using them as indications of the existence of a psychiatric disorder or a mental illness.
The analysis of the Pinel Sanatorium is similar to the study carried out by López Sánchez and Gutiérrez Colín on the La Castañeda General Mental Hospital, one of Mexico’s leading psychiatric hospitals. According to the authors, the admission form and the medical interrogation were the two most relevant documents to assist doctors in deciding on the need for hospitalisation and formulating a diagnosis.
This interrogation aimed to gather information about the patient’s personal and family background, covering a wide range of data such as demographics, physical build, vaccination history, religion, schooling, and level of intelligence. It also sought to identify possible hereditary traits by analysing the family’s mental health conditions, as well as recording the patient’s previous illnesses. As the authors point out, knowing the medical history of the inmates allowed the doctors to identify ‘the characteristics of the illness, extravagances, sayings and acts considered irrational, as well as any behaviour considered abnormal’.Footnote 40
Although the authors do not specify who provided all the requested information, it is possible to assume that it was the individuals being questioned themselves in many cases. As in the cases analysed in this study, the patients’ carers likely provided much of this information. Although the form at the La Castañeda General Mental Hospital contained a specific section for the details of the relative or person responsible for the hospitalisation – in which the reasons for the hospitalisation were questioned – the influence of these reports may have extended to other parts of the document. According to the authors, the information about events and behaviours provided by those who requested hospitalisation was considered fundamental for justifying the hospitalisation and, consequently, for formulating the psychiatric diagnosis.
In the context of both the La Castañeda General Asylum and the Pinel Sanatorium, psychiatrists built up their ‘diagnostic impression of the patient’ during interrogation, through questionnaires or clinical observation. In the process, they assumed a position of authority, consolidating themselves as the legitimate enunciators of the ‘truth’ about madness. Holders of medical knowledge, they were the ones who observed, interpreted, and decided, legitimising themselves as the only ones capable of unravelling the nature of mental illness and determining the fate of the inmates.Footnote 41
With the information from the questionnaire and their personal observations, sometimes also considering the reports of the nurses who accompanied the patients daily, the Pinel psychiatrists constructed their opinions and established diagnoses about the inmates, whose writings were retained. In this case, one of the characteristic features is the oscillation of emotions, normal and abnormal, which I will illustrate with two stories of hospitalisation, that of Lúcio and Dolores.
On 14 September 1935, Lúcio was admitted to the Pinel Sanatorium, taken there by his father, Marino, due to repeated suicide attempts. In the Psychiatric Examination, the psychiatrist, based initially on the information provided by the father in the questionnaire, emphasised the presence of family members with ‘psychological disturbances’ and went on to describe Lucio’s emotional characteristics in detail. Since childhood, he was said to have been ‘always nervous, impressionable and in an unstable mood, going from joy to sadness for no justifiable reason’. There were also reports of an attempted suicide by ingesting four ‘cafi-aspirin’ tablets after a disagreement with his fiancée. After the wedding, Lúcio allegedly showed excessively jealous behaviour towards his wife, even hitting her on one occasion, although, according to the report, he immediately regretted that ‘motor impulse’. At the same time, he was described as a man who was ‘very upright in his business dealings’ and even showed ‘exaggerated scrupulousness’ in his commercial transactions.Footnote 42
According to the doctor, Lúcio’s participation in the 1932 RevolutionFootnote 43 was a determining factor in the onset of his illness, which was already being announced. The triggering event was the bombing by an aeroplane of the ambulance he was driving. From this episode onwards, his nervousness would have increased considerably, accompanied by the appearance of ‘symptoms indicative of an impending psychosis’. It is reported that, on some nights, Lúcio would wake up startled, shouting: ‘There’s a bomb coming.’ Another significant event occurred months before his hospitalisation: the suicide of a close friend, who took his own life by shooting himself with a revolver. After this episode, Lúcio developed an obsession with the idea that he would suffer the same fate and even tried to take his own life.Footnote 44
The doctor goes on to describe Lúcio’s various suicide attempts in the hospital, which he considers ‘inconsequential or even childish’. Among these attempts, he mentions episodes in which the patient plunged ‘his mouth and nose into a bowl of soup with the aim of drowning’ or tried to ‘asphyxiate himself in the water of the bathroom’. He then highlights Lúcio’s behaviour, which oscillated between ‘deep introspection’ and saying ‘disparate things’.
The diagnosis of schizophrenia, about which the doctor claims to have no doubts, is presented after a description of the patient’s specific characteristics. Lúcio showed ‘a tendency towards catatonic attitudes’, sometimes remaining ‘in an orthostatic position, erect, straight, staring at a point, without so much as a facial muscle twitching’. In addition, the doctor noted the presence of ‘auditory hallucinations’, reporting that Lúcio claimed ‘to be in daily communication with his loved ones’. The situation worsened, he went on, with the production of letters ‘without an addressee most of the time’, in which we can identify ‘cabalistic signs’, ‘reticence’, and a combination of ‘flagrant psychological breakdown, a marked tendency towards mysticism’ and ‘ideas of self-accusation’.Footnote 45
After just over six months in hospital, Lúcio was discharged on 24 March 1936, showing a complete improvement in the symptoms of his illness. However, just twenty days later, he returned to the Pinel Sanatorium, presenting, according to the doctor’s report, ‘the entire symptomatological procession’ observed during his first hospitalisation. Subjected to insulin therapy, Lúcio showed ‘clear remissions’, albeit short-lived. As described by the doctor, ‘when the psychological disorders began, ideas of suicide set in’. This pattern characterised his second and final stay at the Pinel Sanatorium. On 28 November 1937, the doctor recorded the tragic outcome: ‘despite the vigilance to which he was subjected, he succeeded in his purpose, resorting to a strap’.Footnote 46
Dolores was hospitalised at the Pinel Sanatorium for a period that coincided, in part, with Lúcio’s stay. Her first admission occurred on 2 January 1936 and lasted until the 16th. She was later readmitted on 25 January and remained at the sanatorium until 5 March of the same year. Although they did not live together directly, since the facilities for men and women were separate and physically distant, the relevant aspect for this analysis is how the doctors interpreted the emotions expressed by both. These interpretations brought them closer together, regardless of the significant differences in their profiles and life histories.
The Physical Examination carried out during hospitalisation and the subsequent Somatic Examination, which provided information on the patient’s biological aspects, such as physical constitution, quality of nutrition, blood pressure, and pulse, mentioned that she was a ‘married woman with four children’. Although irrelevant to Lúcio’s physical qualifications, this detail was considered an essential element in defining what was going on with Dolores, to the point of being included in a space not intended for this type of observation. In addition, it was recorded that Dolores had suffered an ‘induced abortion, lasting two months’ and that her ‘menstruation was scarce, but regular in time and duration’.Footnote 47
As in Lúcio’s case, Dolores’ Psychiatric Examination also reported on her hereditary background. According to the doctor, the patient’s mother said that her father was ‘an inveterate alcoholic’ and mentioned that one of her brothers suffered from ‘encephalitis’. The rest of the doctor’s report is mainly based on information from her mother, a brother, and the sanatorium’s head nurse.
Initially, Dolores was described as ‘a young woman of 28, married for 11 years’, who ‘always lived very well with her husband’, with whom she had ‘four children, all alive and strong’. She was considered to have a ‘docile temperament’ and to be ‘somewhat withdrawn, totally dedicated to the household and looking after the children’, which changed around six months before her hospitalisation. From then on, according to her mother’s testimony as reported by the doctor, there was a drastic change in her behaviour, which alarmed the whole family. Dolores began to ‘show herself to be independent and wilful’, dedicating herself to reading ‘volumes and volumes on women’s rights, female emancipation etc.’ When her mother reproached her, she reacted with hostility, rejecting her advice and, at a certain point, abandoned the home, fleeing to Rio de Janeiro, where a brother later brought her. The doctor reports that both her husband and other family members agreed that the patient had undergone a significant transformation, manifested by an increase in vanity and an attempt to pursue an artistic career, an area for which she had never shown any aptitude or vocation.
In both the first and second hospitalisations, the Psychiatric Examination record, in inverted commas, statements are attributed to Dolores. In these reports, the patient – classified by the doctor as having ‘irreproachable behaviour’ – strongly reproached ‘the relatives who want to make her look sick’. She said that she ‘wasn’t meant to be a martyr’ and wanted to ‘get divorced’, justifying her attitude by the fact that her husband mistreated her and, in addition, she had feelings for another man. Dolores also declared that ‘no one could blame her feelings’ and regretted that ‘the country’s laws did not allow a full divorce, as she wanted, because she would not like concubinage’.Footnote 48
She also told the head nurse that the abortion she’d had ‘just over a year ago’ had happened ‘because of her husband’s demands, who had always mistreated her, even physically’. However, her relatives’ ‘strict moral principles’ always put them on his side, so she was admitted to the sanatorium because her family preferred her to ‘be taken as mad, rather than less worthy’.Footnote 49
When she was hospitalised for the second time, Dolores had spontaneously entered Pinel, motivated by the memory that there was a balance on her monthly payment and the desire to get away from her family. According to the psychiatrist, in the account in which he again puts Dolores’s sentences in inverted commas, her husband had discovered ‘a diary of hers in which he found proof’ of her betrayal, triggering a ‘violent scene’ that resulted in her expulsion from home. Dolores narrated the events from the beginning, emphasising the guilt of her husband, whom she accused of not preserving her affection and of taking her to a ‘bad step’, for which, however, she acknowledged ‘her culpability’. The patient stated that when she decided to leave home, she intended to do so definitively but was disappointed by the ‘attitude of the other’, who had refused to ‘keep her in his company’. This disappointment led to a suicide attempt by poisoning herself with lighting gas, from which she was saved and later hospitalised ‘on suspicion of madness’. In the end, Dolores reported that her brother, aware of the whole situation, had reproached her and advised her ‘to end her life’ as a way of ‘washing away her guilt’. ‘She therefore asked us for advice’, wrote the doctor.Footnote 50
The psychiatrist does not mention what advice he gave Dolores, but he does indicate – in his following note some twenty days later – that ‘the patient’s behaviour continues to be very good’, but that ‘small occurrences, at first sight insignificant’, showed that the patient was not typical. From this, he concludes that her case looks like ‘another case of atypical degeneration’; in other words, this woman was in a border zone between normality and abnormality, as this diagnostic category advocated. In these cases, according to the medical theories in force at the time, the ‘degenerative basis is somewhat obscured by the predominance of the signs that are characteristic of them, (…) thus emphasising that there is no typical form.’Footnote 51
This diagnosis contrasts with the one given to Dolores on her first admission, when she was in hospital for only fourteen days: ‘Incipient schizophrenia?’. The question mark, placed in freehand next to the typed diagnosis, was perhaps due to the difficulty in defining it, as it had only been a few days since she had been hospitalised. As Dolores had been ‘removed prematurely’, the uncertainty remained until the second hospitalisation brought, from the medical perspective, a little more certainty about what was wrong with her.Footnote 52
In addition to the doubts raised by the psychiatrist, which seem frequent, as evidenced by the number of ‘undefined diagnoses’ and undiagnosed patients identified in my sample,Footnote 53 even more profound questions arise. These include the following: what determined the conception of psychological abnormality and the need to hospitalise these two people?
Both were diagnosed with schizophrenia. In Lúcio’s case, the Psychiatric Examination reports relatively clear signs commonly attributed to this condition at the time, such as ‘a tendency towards catatonic attitudes, psychological disintegration, accentuated mysticism, ideas of self-accusation, alongside disorganised suicide attempts’ and auditory hallucinations.Footnote 54 On the other hand, Dolores’ diagnosis of schizophrenia, which is initially questioned and later described as a possible atypical degeneration, is not characterised by the typical signs reported for Lúcio; instead, there are moral judgements regarding her behaviour, her desires and, above all, her relationship with her husband, elements which, according to the doctors, mark her psychological abnormality.
The description of the symptoms of Dolores’s illness is firmly anchored in a gender culture shared by family members and doctors. A clear example is the psychiatrist’s treatment of marital violence in the two cases analysed. Dolores’ complaints about abuse were dismissed by the family, especially by the mother, who said that ‘her son-in-law is a great husband’. The doctor adopted this view and attributed these complaints to the patient’s psychological abnormality. On the other hand, Lúcio’s aggression against his partner, justified in the questionnaire completed by his parent as being due to jealousy and a ‘motor impulse’ that he immediately regretted, was not considered by the doctor to be a central element of the ‘psychological breakdown’ presented by the patient.Footnote 55
A common point of particular interest for this discussion is emotional oscillation as a marker of abnormality. Lúcio, who experienced the trauma of a conflict – in which he almost lost his life and witnessed countless deaths or situations bordering on death – showed intense emotions, described by his family members as intense traces of something present since childhood. Known for being nervous, impressionable, and unstable, oscillating between moments of joy and sadness, the post-conflict Lúcio began to manifest a constant state of alarm, often exclaiming ‘bombing is coming’ during nightmares. The sorrow and grief resulting from so many losses, including that of a close friend who had committed suicide, combined with the persistent fear of bombing even after it had stopped, seem to have led Lúcio to stop expressing any positive emotions, a condition considered typical of normality. Although the doctor identified these emotions, he did not analyse the traumatic impacts of the war – such as fear, hatred, and mourning – on the patient’s process of ‘psychological breakdown’.Footnote 56 Finally, Lúcio’s suicide unequivocally confirmed, from a medical point of view, the abnormality of his emotional state.
From Pacheco e Silva’s perspective, as the ‘strong sex and, as such, more resistant to emotions’, a man could suffer the impacts of ‘psychogenetic factors’ on his ‘somatic sphere’, as happened with Lúcio, but ‘what about the woman who is, as we all recognise, of a fragile and delicate constitution, sensitive and vibrant’? The director of Pinel believed that ‘women’s lives’ gravitated ‘around apprehensions, worries and surprises, longings and disappointments, doubts and uncertainties, which accompany them throughout their lives’. Therefore, the ‘hyperemotional constitution, that state of vibratility so often observed in the female sex, predisposes women to a series of neuroses’.Footnote 57
This clearly explained, from the medical perspective, what happened to the ‘docile’ and ‘withdrawn’ Dolores, a good wife and mother, a ‘devoted’ housewife, who had undergone a ‘radical change’, becoming ‘independent’, ‘wilful’, ‘hostile’, and ‘excessively vain’. She confessed to cheating on her husband, saying she ‘had no vocation to be a martyr’, and taking a stand against her family by claiming not to be mad. She had a hyperemotional constitution!
Dolores spoke of her sadness, which she said stemmed from the mistreatment she had received from a man she had married at seventeen ‘against her will’, with whom she had always been ‘incompatible’ and from an abortion caused ‘by her husband’s demands’, as well as the predictable tiredness of the perhaps heavy routine of domestic life and caring for four children. She also spoke of the hope of new possibilities in life; hope that arose from reading about ‘women’s rights’ and ‘women’s emancipation’. These readings may have shown Dolores that there was a world beyond the one where she lived, in which she could be a radio singer and love fully. However, none of this was possible considering the ideal of femininity that prevailed in her social group, despite the ongoing changes that challenged the boundaries between the sexes,Footnote 58 as attested to by the publications she read.Footnote 59
The gender patterns and roles established in Brazilian society, together with the prevailing emotional device – incorporated into both psychiatric theory and practice – meant that, in most cases, the objective criteria announced for the diagnostic assessment were replaced by ideal criteria, especially in the case of women and some men.Footnote 60 By ceasing to be docile and withdrawn, probably sad, Dolores became abnormal – either a beginning schizophrenic or a proven atypical degenerate – and it remained for her, as a kind of resistance in accommodation,Footnote 61 to tell the doctor that she had ‘good intentions for the future’, because she intended to ‘return to the company of her husband, taking into account the welfare of her little children’. This decision eventually allowed Dolores to be discharged permanently.Footnote 62
Playing with emotions
On 16 January 1935, Natanael Borges, a 25-year-old single man, teacher, and resident of the capital, was taken by ‘police inspectors’ to the Pinel Sanatorium at the request of his father, Lauro Borges. A little over four years later, on 17 April 1939, Manuel Feitosa Cardoso, a 47-year-old married man, pharmacist, and resident of Angatuba, in the interior of the state of São Paulo, was also taken to the Pinel Sanatorium, led by representatives of the police force and accompanied by several people from the locality where he lived.Footnote 63
Although the police took both, the reasons for their admission to Pinel were very different. Manuel was taken to the sanatorium because he had shot the priest of the town where he lived since he believed that he had seduced his wife; Natanael, in turn, was taken because he ‘showed a tendency towards homosexual practices’. Manuel did not make it to his first month in hospital and was removed by his family, ‘against the advice’ of Pacheco e Silva himself, who signed the Psychiatric Examination, ‘as he was a persecuted-persecutor of maximum potential danger’; Natanael stayed in hospital for around six months and was discharged, as indicated by the report in his psychiatric records: ‘Apart from a certain apathy and indolence, we noticed nothing else during Mr Natanael’s stay at the Sanatorium, who said he regretted his behaviour and was ready to regenerate after returning to ordinary life.’Footnote 64
Without any diagnosis, Natanael remained hospitalised for half a year, being released only after showing repentance and a willingness to regenerate. On the other hand, Manuel, diagnosed with paraphrenia and whose time in the sanatorium was brief, did not need to show any regret for shooting the priest, nor did he need to show a willingness to regenerate and avoid this kind of behaviour to be released.
The trajectories of these individuals presented side by side in this text differ significantly and are brought together here to problematise the possibilities and limits faced by specific individuals in the face of knowledge and powers, such as those of medicine or families. The institutional histories of Manuel and Natanael are used as examples to reflect on the emotions related to the experiences, both past and present, recorded in their manuscripts. I seek to understand the meanings these emotions possibly had for these individuals and how they were employed as part of a game that involved emotional resistance and negotiation with those who, in the context of the prevailing emotional device, occupied a position of superior status concerning their voices.
Manuel
While hospitalised at Pinel, Manuel wrote a letter addressed to ‘Mr. Director of the Pinel Sanatorium’. In thirty-one pages, in what was the longest of the letters found in the medical records, its author described the events that resulted in the assassination attempt on the priest from the town of Angatuba, in the interior of the state of São Paulo. His story was initially told orally to doctors Pacheco e Silva and Nelson de Toledo Ferraz, who examined him the day after he was hospitalised. The doctors allegedly won his ‘trust’ by promising they would work ‘to get him out of the hospital’. Pacheco e Silva wrote the examination, but Ferraz encouraged Manuel to put down on paper the story he had told them both ‘passionately and in great details’.Footnote 65
Twenty days into his hospitalisation, on 7 May 1935, Manuel finished his letter, as indicated by the date at the end, accompanied by his signature. The text begins with an introduction of the author: ‘Manuel Feitosa Cardoso, Brazilian, pharmacist, married, 48 years old, living twice, in Angatuba where he has a pharmacy, and in Juiz de Fora, at Rua Manoel Bernardino 123, where he is bringing up his children.’ Manuel then describes aspects of his personal and professional life, including his marriage to Mercedes Veloso de Freitas, the daughter of an influential local politician. Initially prosperous, the marriage was marred by family conflicts and financial losses caused by his brothers-in-law. Manuel also reports an adultery case involving his wife and Father Afonso Moreira from the parish of Angatuba, a fact that was documented by his daughter, Magdalena. The letter highlights, in its first pages, the tensions between Manuel and his family members, as well as the accusations made against the priest, to whom he attributes the destruction of his honour, harming his life.Footnote 66
Manuel, who says he feels unjustly deprived of his inheritance by his brothers-in-law, suspicious of his wife’s betrayal, and convinced without ‘any more doubts [about] who had made his two daughters miserable forever by prostituting their mother’, describes a sequence of intense emotions. He also believes that he is being pursued ‘by the priest’s men who are trying to murder him’ and conjectures that ‘she [his wife] knew about the sinister plot’. In addition, he recounts the sensation of being ‘hunted down like a beast by the hunters’, which he heard while walking along the ‘lining of his house’.Footnote 67 With such circumstances, Manuel channelled his emotions through writing, undertaking a profound catharsis. Perhaps, ‘the cathartic sensation of letting out so much stored up, of exorcising ghosts from the past, killing them again dead on paper’,Footnote 68 in response to the impossibility of directly confronting those who, real or imagined, caused him fear and suffering, allowed him to rework his own life at that moment.
Finally, Manuel stated that he felt confident in the institution that housed him, the Pinel Sanatorium, ‘which has a heritage to protect and whose social mission is very high’, to ‘bring the fact to the attention of the Investigations Delegate’, who was to request various measures, such as hearing key witnesses, investigating his home and obtaining statements from his wife and daughter about the priest’s involvement in acts of dishonour and threats to his life. Finally, Manuel calls on the Sanatorium to take responsibility and defend his honour and safety.Footnote 69
Although the Pinel psychiatrists did not consider Manuel’s account plausible – described as ‘a well-systematised persecutory delirium’, in which he went so far as to include ‘doctors and nurses among his persecutors, as possible allies of the priest he had shot’ – or perhaps precisely for this reason, they helped to ensure that the ‘deprivation of senses’ argument was used in his defence. Two letters from Juiz de Fora after Manuel left the sanatorium indicate that the doctors issued a medical report and attached it to the case brought against him.
In the first letter, dated 4 June 1939 and addressed to ‘Professor Pacheco e Silva’, Manuel mentions the imminence of the trial in Itapetininga. He states his plan to seek the report at the Sanatorium. He says he intends to be ‘more discreet’ in his ‘statements’ and to use the argument of ‘deprivation of senses’ in his defence. The letter ends with reaffirming his confidence in Pinel’s support: ‘My conception of reason goes today as far as sincerity exists, beyond that is imprudence, falsehood always prevails. So, I can count on Pinel’s patronage.’Footnote 70
The second letter, dated 27 October 1941 and sent to ‘Dr Nelson de Toledo Ferraz’, shows that Manuel was re-established professionally, as it uses the letterhead of ‘Farmácia Santa Honória, do Farmacêutico Manuel Feitosa Cardoso’, in Juiz de Fora. In this letter, he expresses his gratitude to the Pinel doctors for his freedom and the recovery of his civil rights, mentions the difficulties he faced in the court case in Itapetininga, and celebrates the victory he won. He also affirms his commitment to the fight against endemic diseases and makes himself available to the doctors to repay their help.Footnote 71
From a medical point of view, this letter, written more than two years after his hospitalisation, shows various signs of persecutory delirium, as evidenced by passages such as: ‘Our struggle was fierce, and we won proudly, even though the burglars of my house, my aggressors and those who stole my degree ring, money and jewellery from the house were informed.’Footnote 72
What would have allowed Manuel, diagnosed with paraphrenia, to re-establish himself professionally and, as this letter indicates, escape both the ban and the sentence for the attack on the priest?
The articulation of specific social markers may explain this. Manuel, being a man with a certain level of material possessions, a recognised profession, a family man, and a respectable citizen, seems to have had his aggression – motivated mainly by the suspicion of his wife’s adultery with the parish priest – overlooked by the instances of knowledge and power that surrounded him, such as psychiatry and justice. Although his act was reprehensible and he was, at one point, characterised as a ‘dangerous stalker’, it was also considered justifiable because he had been driven by intense emotion due to the suspicion of adultery, which had deprived him of his reason and made him act outside normal standards. It is important to note that ‘deprivation of the senses’ was recognised as a mitigating factor in crimes against life, as provided for in Brazil’s Republican Penal Code of 1890, which was still in force. Article 27, item IV, stated: ‘Those who are in a state of complete deprivation of senses and intelligence at the time of committing the crime are not criminals.’Footnote 73 As numerous cases discussed in different studies show, this argument was widely used in the defence of defendants accused of crimes considered to be ‘crimes of passion’, who were not seen as being as dangerous as other common offenders with ‘perverse instincts’. Even though Manuel did not direct his aggression directly at his wife – whom he also threatened to kill – but at her alleged lover, it is possible that his behaviour was framed as a ‘crime motivated by passion’.Footnote 74
Or, at least, that was the narrative that Manuel skilfully constructed to support his defence. It is impossible to deny that he showed skill in handling speeches – he knew how to play the game – by arguing that his actions were motivated by intense emotions that deprived him of his senses. By choosing to ‘be more discreet’ in his ‘statements’ – adjusting, albeit momentarily and tactically, his most intense emotions – Manuel was able to rebuild his life and regain his social position.
Natanael
As mentioned earlier, the young Natanael Borges was admitted to the Pinel Sanatorium at the request of his father, who was responsible for applying for admission, accompanied by a medical certificate signed by ‘two medical officers, Dr Torres Neto and Dr Pedro Augusto da Silva’.Footnote 75 Designed by Pacheco e Silva, Natanael’s Psychiatric Examination included information provided by his family, which substantiated the justification for his admission. Based on this information, the doctor described Natanael as a dedicated and hard-working young man who founded the Liceu Acadêmico Belo Horizonte (Belo Horizonte Academic Lyceum) with the help of his sister. She was later removed from the administration, and the management was entrusted to ‘Professor José Carlos Flores, who had absolute control over him’ and with whom he began to live and share the same room. The family, unhappy with this situation, interpreted their living together as an indication of homosexual practices. Faced with unsuccessful attempts to change their son’s behaviour – considered ‘depressing and humiliating not only for Mr Natanael but for the whole family’ – they opted to have him admitted to the sanatorium. According to the doctor, the parents attributed such behaviour to a ‘morbid perversion’, in clear contrast to the strict upbringing and traditional moral values they had passed on to their son.Footnote 76
Although the report alludes to the initial moment of hospitalisation, it seems to have been written at the end of the hospitalisation period, considering the doctor’s mention of the ‘long waiting time for the interdiction mental examination’, during which Natanael remained hospitalised, as well as the observations about his behaviour throughout this period.
According to Pacheco e Silva, ‘in this Sanatorium, Mr Natanael has not shown any sensory disturbances; however, he has shown himself to be mannered, affected and effeminate.’ In addition, he ‘denies the facts of which he is accused, but does so without vehemence, insisting that his business be entrusted to his partner and not to his family, as can be deduced from the attached letters’. The examination also identified ‘some deficiencies in critical judgement and, above all, a certain moral insensitivity’, evidenced by Natanael ‘talking naturally about the reasons that brought him to this Hospital’. The doctor writes that, during the ‘long waiting time for the mental examination to be interdicted’, Natanael initially showed revolt at his hospitalisation. However, when he realised that his and his partner’s efforts to get him released had been ‘unsuccessful, he settled for the situation’. Apart from ‘a certain apathy and indolence’, the doctor did not identify any other relevant aspects during his stay. Finally, he states that Natanael declared that he was ‘sorry for his behaviour and willing to regenerate’, seeking a reintegration into ‘ordinary life’.Footnote 77
The medical opinion clearly shows the conception that characteristics such as being ‘mannered, affected, effeminate’ were signs of a psychological abnormality, reinforced by the lack of ‘critical judgement’ and ‘moral insensitivity’ observed in the way Natanael talked ‘naturally’ about such issues. The bodily and behavioural signs – such as the fact that he lived with his ‘friend’ and wanted him to run ‘his business’ – were interpreted by Pacheco e Silva as confirmations of the family’s allegations, which attributed to the young man a ‘morbid perversion’.
On the other hand, Natanael’s clear expression of his understanding of the reasons that led to his hospitalisation can be understood as a result of his trust in the doctor assessing him. Natanael may have perceived in the psychiatrist, who was also relatively young and an enlightened scientist, a potential ally, capable of understanding his identity without making moral judgments. In other words, someone who could stand against his father’s ignorance or intransigence. So, Natanael rebelled, argued, spoke openly, and then wrote about what he was experiencing. However, this was a mistake on his part.
As the bibliography shows, ever since he began his professional practice at the Juquery Hospital – a pattern he maintained in the other institutions where he worked as a doctor or professor – Pacheco e Silva always pathologised sexual practices that deviated from the heteronormative standard and that broke the limits of marriage. These practices were ‘considered “abnormal” by him and subject to intervention by psychiatrists’.Footnote 78
Like the doctor, Natanael’s mother showed no solidarity with his demands, as evidenced by the letters he wrote to ‘Dear Professor José Carlos Flores’, whom the family identified as his lover.
In the first letter, written shortly after he was admitted to the sanatorium, Natanael is convinced that his mother was an ally in his resistance to hospitalisation and would act as an intermediary to keep José Carlos Flores in charge of the Lyceum. Prevented by ‘internal regulations’ from communicating directly, he informs him that the letter – which never reached its addressee – was being sent via a person called ‘Mr Ferdinando’. The aim was for Flores, armed with the correspondence, to present himself ‘as soon as possible at the Lyceum, so that he could take care of it’ with his mother.Footnote 79
In the message, Natanael recalls the existence of a document he signed, emphasising its judicial value, which would guarantee José Carlos the right to take part in the running of the Lyceum. It also gave him the authority to supervise the financial administration of the institution, including the collection of tuition fees and the payment of uniforms for students on the Brazilian Army’s reservist training course. He then informs him that his mother had already made the payments and that he had come to an understanding with her, planning to later clarify to his father ‘the way you should be treated at the lyceum’. Natanael tells José Carlos that he can continue to pay the rent for the ‘room in Rua Oriente’, stay there if he prefers or move to another location. He also assures him that the teacher should continue to receive his salary. However, the document does not specify the exact amount, which suggests that previous payments could have been variable.Footnote 80 In the final section of the letter, Natanael encourages Flores, whom he refers to as ‘your friend’, to remain in charge of the Lyceum:
Flores, come without fear because you have the full right and duty to attend once you’ve continued with my declaration. I have made a deal with Mum, and to avoid anything, she will only go to the Lyceum. My brothers will be independent of the movement, i.e. the Lyceum. I’m asking you to listen to Mum because she’s really kind. I’m the one who made a big mistake. As soon as I arrive at the Lyceum, maybe you’ll take over as headmaster, and I’ll go and study medicine.Footnote 81
Natanael says goodbye, expressing how much he misses everyone, especially José Carlos, and wishes to be visited by him in the sanatorium’. Not knowing that his correspondence would never leave the sanatorium, he said that he would remain hospitalised out of respect for his parents’ wishes ‘until they see fit’. Natanael also instructs José Carlos Flores to continue ‘working quietly for the progress of the lyceum’, as if he ‘were there’.Footnote 82
On 25 January, Natanael wrote another letter to José Carlos again, believing it would reach the addressee. This time, he emphasised the need for discretion: he asked him to avoid telephoning or sending correspondence and to ensure no one knew about their communication. He justifies this by saying that if ‘they find out that people outside the family know I’m here, they might send me somewhere else’. He adds: ‘Don’t even tell anyone how the letters came about.’Footnote 83
This second letter has a less tranquil tone than the previous one. In the first letter, Natanael shows that he believes in his mother’s goodness and complicity, maintaining an attitude of respect and consideration for his parents despite everything. In the second, he shows fear and revolt. Addressing José Carlos as ‘Friend and brother Flores’, Natanael insists he ‘does not lose heart’, blaming the family for ‘everything that’s happening’. He encourages the ‘friend’ to react, ‘whatever it takes’, in the face of the difficulties related to the family’s rejection of his alleged lover’s presence at the Lyceum, even with the ‘necessary authorisation’ granted by him. In addition, he advises Flores to send the authorisation to a lawyer and mentions that he had sent information about her ‘case’ and ‘situation’ via someone called ‘Zezinho’. A string of emotionally charged words appears at the end of the short letter: ‘Flores, I can’t bear the longing, but I dare to suffer and fight on, whatever the cost. Only death will separate us. Yours, your brother and friend.’Footnote 84
Natanael’s third and final letter was written on 20 March 1935 and addressed to his ‘kind mother’. Before succumbing to ‘apathy and indolence’, as described by Pacheco e Silva, and abandoning his resistance to the hospitalisation and removal of José Carlos Flores, whom he wanted to see in charge of his business, Natanael confronted his mother. This maternal figure, who he initially believed to be his ally against what he considered to be absurd – his hospitalisation and interdiction – became the focus of his protest. The narrative highlights Natanael’s internal conflict in the face of the rupture of his expectations regarding family support while simultaneously exposing his struggle to remain connected to what he considered essential in his life.
The letter indicates that Natanael was somehow able to act in his defence, either through his lawyer or through the intervention of José Carlos, with whom he established contact through other means, since his letters had been retained. In his narrative, he contests the accusations that resulted in his deprivation of liberty, his removal from his professional activities, and from the man he called ‘brother’ or ‘friend’. The accusations refuted by Natanael appear to have been presented in a letter sent to him by his mother, but this correspondence is not archived in his medical records.
The letter, written in impeccable handwriting, begins affectionately, with Natanael expressing ‘how much I miss you’ and congratulating his mother on her birthday. Quickly, however, the tone of the correspondence changes, showing a more defiant attitude, as he expresses, in a frank and resolute manner, the difficulty of meeting the recipient’s expectations: ‘I’m sorry I can’t be pleasant to you in reply to the letter that comes with your name.’ The following statement reveals her willingness to confront the feelings involved directly: ‘My intellectual and moral culture, thanks to your efforts, cannot come up with a fictitious sentimentality to make you simply happy.’Footnote 85
Nathanael then justifies his decision not to reply directly to the letter he received, as this would mean disagreeing with specific facts described in it, setting out his ‘reasons’ and therefore disagreeing with ‘certain facts described in it such as: Friendly illusion. Uncertain routine. Medical daring. Police trickery. Role of Iscariot’. Although he refuses to detail the points of disagreement, Natanael anticipates his intention to spare the addressee unnecessary inconvenience, avoiding ‘upsetting and disturbing her’. At the same time, he seeks to justify his behaviour and attributes a greater purpose to it when he says, ‘I, armed with an iron will, will be the safe rudder on the great ocean of life, thus achieving the name that will make my family proud.’ The use of these metaphors emphasises the author’s self-confidence at this time in overcoming the adversities imposed on him.Footnote 86
A legal issue is addressed next in the letter, with Natanael taking a stance to dispel another accusation made by his mother, that of a supposed lawsuit against his father: ‘That letter talks about a lawsuit against Dad, but it is not a lawsuit against him, but a request for Habeas Corpus that I made to the judge.’ The request for Habeas Corpus was based on the circumstances in which the police had arrested him and subsequently interned at the Pinel Institute, which he considered to be unjust and carried out in degrading conditions: ‘I was arrested by the police and brought to the Pinel Institute, where I was interned in unpleasant conditions that could not be attributed to me: mental disorders and homosexual tendencies.’ Natanael vehemently rejects these attributions, arguing that they were based on other people’s statements – ‘the first by Papa, who attached a medical certificate, and the second by Dr Pacheco, Director of the Pinel Institute’ – and not on concrete facts. Not admitting these accusations and protesting against an internment that had even left him ‘incommunicado’, Natanael states that ‘in his right mind, understanding and health’, considering his ‘internment in the Sanatorium to be “illegal” (as approved by the Public Prosecutor Dr Ataliba Nogueira)’, he had appealed ‘for justice’.Footnote 87
In the last paragraph of the letter, the author states that he believed ‘that he could leave the Sanatorium with the same politeness’ with which he had entered it, because the ‘false label of rest’ that had justified his hospitalisation, expelling him ‘out of the blue, from the (…) Lyceum of which he was Director and from the Presidency of T. J. 20’, had been based on ‘false and very inconstant claims’. In his words, these had caused his father to avoid ‘sensibly analysing the truth’ and to be ‘forced to proceed in the way that happened’. At this point, there is no confrontation but rather an attempt at negotiation by convincing people of the existence of reciprocal errors, which would have resulted in the hospitalisation. It was this, according to Natanael’s argument, and not a challenge to the family order or social and gender norms, that engendered the events. That was why he appealed to the courts and waited for their decision, as he writes in his letter.Footnote 88
Natanael closed his letter by saying to his mother, ‘What I want is for you to remain calm, as well as everyone at home.’ He thus reiterates his affection and concern for the well-being of his family, to whom he sends his ‘regards’.Footnote 89
Denying the main accusation that had motivated his hospitalisation at Pinel and, consequently, his removal from his business employing a civil interdiction, which I’m not sure was carried out, Natanael tried to play the game that had been imposed on him. Not believing in any partnership, at the level of understanding and acceptance, on the part of his doctor, he dismissed the statements he said he had made about his homosexuality, calling the statements of both the doctor and his father confusing and divergent. Far from a ‘fictitious sentimentality’, but seeking to maintain his ‘politeness’, a gentle attitude that expresses a positive emotion, contrary to the perverted or depraved ones attributed to those who engaged in homosexual practices, Natanael appealed for his rights in the letter mentioned, as I have indicated.
However, none of this seems to have worked. His legal and personal appeals had no effect because, as Pacheco e Silva reported, ‘his efforts and those of his partner who was interested in his leaving had been fruitless’. Natanael only left the sanatorium when he ‘came to terms with the situation’, promising to adjust to family and medical expectations about his sexuality, saying he ‘regretted his behaviour’. What happened seems to have been an act of resistance in accommodation, in the same way Dolores had acted. It was an adjustment to the prevailing emotional device, which involved denying his sexual orientation. By claiming to be ‘willing to regenerate’, at least in front of those who had the authority to ‘give him his ordinary life back’ – his doctor and his family – Natanael won his freedom.Footnote 90
But what kind of freedom was this? Certainly not the one desired by Natanael, in which love for an individual of the same sex – clearly expressed in the second letter addressed to João Carlos – was not considered an abnormal emotion.
Homosexuality would increasingly become a psychiatric problem, with all emotions and practices related to it being considered abnormal. In 1948, it became part of the International Statistical Classification of Diseases and Related Health Problems (ICD). In the sixth revision, ‘homosexuality’ was included in subcategory 320.6 – Sexual Deviation. From then until 1990, when the World Health Organisation removed it from the ICD, ‘homosexuality’ was maintained in the successive revisions that this type of manual underwent.Footnote 91
The inclusion of the ‘homosexuality’ in the International Classification of Diseases (ICD) and the Diagnostic and Statistical Manual of Mental Disorders (DSM) of the American Psychiatric Association (APA) reinforced the convictions of Pacheco e Silva who, from the time of the events studied, remained active in combating practices and emotions that he considered to be deviations from human nature. For the psychiatrist, social stability was linked to the preservation of sexual morality, respect for ‘chastity, virginity, pudency, decency, marital fidelity, and normal sexual relations’. In this sense, he argued, civilised societies had always combated promiscuity and ‘sexual perversions, such as homosexuality’, a true ‘aberration of nature’.Footnote 92
Had Natanael somehow managed to circumvent the rigid restrictions imposed on him, restrictions marked by episodes of profound violence, as evidenced by his hospitalisation and attempted judicial interdiction? Had he and João Carlos resumed their love affair, albeit under the cloak of clandestinity?
Although this hypothesis is plausible, its counterpart cannot be overlooked: the possibility that family and social pressures continued to exert force on the once daring Natanael. In a past of freedom, he had been enterprising and had dared to share his life with a partner of the same sex. Have the intense emotions that once pulsed through Natanael, such as passion and obstinacy, been replaced by others of an opposite nature, such as fear and resignation?
The emotional resistance visible in his letters, exposed in a harsh or negotiated way, may have given way in the face of obstacles that Natanael was unable to overcome. Thus, entangled in the intricate webs that imprisoned him, he may have become the apathetic and resigned person in Pacheco e Silva’s account, an emotional stance that the psychiatrist seems to be proud of, as it indicates that the disciplining power of institutional practices affected him. However, if this were the case, would such a transformation be definitive, marking the course of Natanael’s existence forever?
He did not return to the Pinel Sanatorium, which became a public institution a few years after his visit. Still, perhaps he went on to other spaces for disciplining bodies and minds, aimed at the wealthier classes in the city of São Paulo.
Conclusion
Marília, Valentina, Dolores, and Luísa – mentioned in this text – as well as Helena, Maria Antônia, and Heloise, referred to as ‘domestics’ or without any record of their profession, are the women whose letters I found in the Pinel archives. Aldemir, Valentim, Paiva, Dr Jorge, and Dr Frederico are some of the other twenty men who, along with the aforementioned Lúcio, Manuel, and Natanael, made up the population of those who left records of their time at the Sanatorium. Between the late 1920s and the 1940s, these men with different occupations – simple farmers, teachers, lawyers, and engineers, whose surnames were streets in the expanding metropolis – and the women were part of a ‘hierarchical emotional device’. This device was structured by ‘strategies, technologies, coercions and persuasions’, which involved various social groups, such as families and psychiatrists, as well as institutions that believed in the function of the psychiatric institution as a tool to ‘reconduct and reform’ behaviours that were considered disruptive and emotions that were out of the norm.Footnote 93
They also actively participated in this mechanism, sometimes adapting and sometimes resisting. The ‘emotional resistance’ outlined in the relationships in the hospital sometimes took the form of negotiation or resistance to accommodation, as when Dolores told the psychiatrist she had ‘good intentions for the future’ or when Natanael said he was ‘willing to regenerate’. But on many other occasions, ‘emotional resistance’ is expressed more vigorously, through escapes announced in correspondence, in writings that despise or mock medical assessments; in others that report complaints of mistreatment outside and inside the institution, promising to denounce the injustices experienced in the newspapers; or even through suicide, an extreme line of escape, as Lúcio did. Emotional resistance, as Rosón and Medina Doménech say, ‘does not have to be completely innovative, but it does show us a creative human conscience that is worth rescuing (…), since it can be read as a “repository” of knowledge, a “repository” of good living.’Footnote 94
Both the medical reports in the Psychiatric Examination and the content of the letters reveal, albeit from different perspectives – sometimes highlighting the abnormality, sometimes emphasising the potential of the subjects –, the movement of emotions and the play with them. Emotions, far from being simple substances in ‘our blood’, are social practices organised by stories we act out and tell. Our ways of understanding structure them,Footnote 95 as I have endeavoured to demonstrate throughout this text.
On the other hand, as I pointed out right from the start, the social markers that constructed the subjects, visible both in the trajectories I have briefly outlined here and in those of the other people who wrote letters, continued to fulfil their role in establishing equalities and differences within the modern sanatorium. All the interned people were equalised along three main lines: the condition of being suspected of being mad – with or without a defined diagnosis –; under their more privileged social status – which allowed them to pay for their stay in a private institution –; and by their ‘ethnic data’ declared on the internment form – white. However, they were differentiated when the family, then medical knowledge, evoked the prevailing standards and norms of gender and sexuality in the definition of normality/abnormality.
In the Pinel Sanatorium, as in other similar institutions – widely analysed by the historiography of madness and psychiatry, as well as by gender studies, especially those focused on mental institutions – the social markers of difference had a more significant impact on women than on men. Women’s hospitalisation was often justified by the so-called emotional excesses inherent in female nature, as in the case of Helena, described as ‘spectacular, with theatrical attitudes’, ‘rebellious’ and ‘extravagant’.Footnote 96 In addition, the breaking of moral norms associated with the wife/mother/housewife triad was also the reason for these hospitalisations, as exemplified by the case of Marília, who was involved in a ‘violent scene of blood (…) killing her lover with axes and gunshots.Footnote 97
In this sense, complaints about physical, psychological, moral, sexual, or property violence by their male partners were disregarded. On the other hand, a man’s violence, motivated by so-called ‘passion’, could act as a mitigating factor for his madness, if it was understood as a temporary ‘deprivation of the senses’ or the result of a ‘motor impulse’ followed ‘immediately’ by repentance, as in the cases of Manuel and Lúcio. However, if a man was openly homosexual – like Natanael – there was little chance that he would not be considered to have a ‘pathological personality’, especially if such an orientation became public, jeopardising the reputation of well-established families in local society.
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