Introduction
Most histories of mental hygiene accord a privileged, if not exclusive, place to Clifford Whittingham Beers (1876–1943), a young American university student without medical or psychiatric training, and to the publication of his A Mind That Found Itself (1908), in which he recounted his experiences as a patient and the suffering he endured in a number of psychiatric institutions. As will be shown, the successive reissues and reprints of the book not only confirmed but also reinforced Beers’ central place in the gradual organisation of a mental hygiene movement that, during the 1910s, expanded at both state and national levels.
At the international level, ‘official’ accounts highlight his role in the founding of the Canadian National Committee for Mental Hygiene (CNCMH) in April 1918 – often presented as little more than an annex or extension of the American National Committee – as well as his proposal, in February 1919, to establish an International Committee for Mental Hygiene.Footnote 1 In this respect, it may be argued that the dominant historiography of the movement has given scant attention to the contributions of other figures and institutions to its international or global dissemination. Ultimately, the involvement of other actors has often been acknowledged only in relation to their co-operation with, or opposition to, the initiative launched in the USA by Beers.
This article offers a critical reading of that mainstream narrative, drawing on historical sources that have hitherto received little attention, as well as on newly available archival material. Building on a body of scholarship since the late 1980s, which has itself challenged the prevailing narrative, it seeks to advance a new framework for understanding the history of the international mental hygiene movement as it developed during the first half of the twentieth century. From this perspective, it becomes possible to recognise the multiplicity of determinants at work in a history that diverges markedly from any linear or progressive trajectory emanating from a single, exclusive centre.
As will be explored in greater detail, the organisation of the mental hygiene movement, both locally and internationally, while closely linked to certain sectors of psychiatry, never crystallised into a discipline with clearly defined boundaries. Indeed, it intersected with a range of other fields – social hygiene, neurology, paediatrics, and, most notably, social work – at different stages and in different contexts.
Without resorting to an ‘anarchic’ vision in which the radical diversity of national or local projects would preclude any form of coherence, the aim here is to examine the variety of initiatives and the circumstances that led diverse actors – individuals, groups, and institutions – who identified themselves as promoters of mental hygiene at national or local levels, to situate themselves within the framework of a complex international movement operating across multiple planes.
This ‘off-centred’ history thus seeks to illuminate the complexity of the ‘international’ question in the mental hygiene movement, through the study of diverse cases, which highlight both the conflicts it provoked and the different meanings and significance attributed to it in distinct contexts. Accordingly, the following sections will first situate the emergence of a ‘new history’ of mental hygiene around the mid-1980s, then examine the early development of the movement in the USA and Europe, before turning to its trajectory in Latin America during the first half of the twentieth century.
Traditional historiography and ‘new history’ of the mental hygiene movement
The concept of mental hygiene is difficult to define. Its ‘polysemic nature’ and ‘imprecise borders’Footnote 2 have already been highlighted by historical research, which, in the case of the English language, places its origins around the mid-nineteenth century. However, as previously mentioned, historical accounts published up to the 1980s situate the origins of mental hygiene in the early twentieth century in the USA.
The version most widely – if not exclusively – disseminated among English-speaking readers, and also influential among Spanish-speaking audiences, traces the movement’s origins to the publication of A Mind That Found Itself in 1908 in the USA. In this book, as noted above, a young Yale graduate and former psychiatric patient named Clifford Whittingham Beers describes the mistreatment he endured over a period of three years in various psychiatric institutions following a suicide attempt. This account is considered to have laid the foundation for the establishment of the first Society for Mental Hygiene in Connecticut in the same year. A year later, the creation of the National Committee for Mental Hygiene (NCMH) marked its national expansion, and by the 1920s, it had attained an international dimension.
The additions introduced in the successive editions and reprints of Beers’ book are particularly significant here. In the fifth revised edition, published in 1921, a section on ‘The Mental Hygiene Movement’ was added, written by Beers himself ‘in response to a demand for an account of the origin and growth of The National Committee for Mental Hygiene’.Footnote 3
In the dozens of subsequent reprints, notable additions were made. In 1935, a text titled ‘The Mental Hygiene Movement and Its Founder’ by Charles-Edward Amory Winslow (1877–1957), president of the Connecticut Society for Mental Hygiene, was included.Footnote 4 In it, he argued that, since human personality is the object of both psychiatry and mental hygiene, its significance could be exemplified through the story of Clifford Beers, the founder of the mental hygiene movement, demonstrating what his personality ‘has accomplished for the welfare of the human race’.Footnote 5
Even after Beers’ death on 9 July 1943, further texts were added to reaffirm his central role in the history of the mental hygiene movement. In the 1948 edition, a text by Luther E. Woodward (1897–1961), a member of the NCMH, outlined its most recent developments, justifying this inclusion with Beers’ own wish, recorded in his will, that ‘all editions of his autobiography shall include a record of the continuing progress of the movement [which he started]’.Footnote 6 Finally, in the thirty-third edition of A Mind That Found Itself, Nina Ridenour (1931–2019) stated that ‘[u]nder the arrangement that Clifford Beers himself planned, the story is now carried through the postwar years to the beginning of 1953’.Footnote 7 A few years later, this same author asserted that the World Federation for Mental Health, founded in 1948, was a ‘direct descendant of Clifford Beers’ original International Committee for Mental Hygiene’ as part of ‘his dream of a world-wide mental hygiene movement’.Footnote 8
This ‘traditional historical perspective’ of the mental hygiene movement remained dominant throughout the twentieth century: It was characterised by the prevalence of autobiographical accounts and testimonies in a broad sense, often written by those directly involved in mental hygiene organisations and serving a clearly self-legitimising purpose.
Yet, even in more recent literature, produced outside the circle of adherents to these institutions – which, moreover, remained the dominant perspective until the 1980s – Beers’ central role continued to be emphasised. In the biography of Beers written by Norman Dain (1980), although he did not adopt the celebratory tone of previous texts, it is stated that ‘mental hygiene activity abroad [USA] had grown from seeds planted by himself and others in the United States and Canada’.Footnote 9 Almost thirty years later, Bertolote and Pols emphasised the influence of the American mental hygiene movement abroad: The former noted its role in fostering national associations after 1919, while the latter stressed how psychiatrists adapted the US model to develop mental health care in their own countries.Footnote 10
What could be considered the earliest proposals for a ‘new history’ of the international mental hygiene movement emerged in the 1980s. One work that stands out, although it does not lead specifically with the movement on an international level, is the remarkable and wide-ranging research by Gerald Grob (1931–2015) on psychiatric care in the USA, who devotes a chapter of his book Mental Illness and American Society (1875–1940) to the Mental Hygiene Movement. This research succeeds in ‘decentring’ the local history of mental hygiene from the figure of Beers and shows the relevance of his relationship with the local ‘psychiatric field’ as well as certain characteristics of contemporary American society and culture, such as the distinction between the ‘prevention’ of the nineteenth century and the ‘mental hygiene’ that began to be promoted from the twentieth century onwards.
More precisely, without underestimating the figure of Clifford Beers, Grob’s work highlights the enthusiastic moral and financial support he received from the philosopher and psychologist William James (1842–1910). It also underscores the importance of his association with Adolf Meyer (1866–1950), a prestigious psychiatrist of Swiss origin who emigrated to the USA around the 1890s and shortly thereafter took up the chair and psychiatric clinic at Johns Hopkins University. In 1907, Beers sent him a draft of his book, and they had several extensive meetings and correspondences to discuss the text. Additionally, when Beers wanted to found a National Society for the Improvement of Conditions Among the Insane, Meyer advised him to create a Society for Mental Hygiene, ‘to show our people better ways of healthy living, prevention of trouble, and efficient handling of what is not prevented’.Footnote 11
Meyer’s suggestion for an organization devoted to ‘mental hygiene’ actually introduced a new element; it deflected Beers’s original emphasis on institutional improvement and directed it toward the far more amorphous goal of promoting mental hygiene. But, like most of his colleagues, Meyer never spelled out with any degree of clarity the precise content of such a concept.Footnote 12
The first historical research on the international movement was published in 1995. It is a text that has become a ‘classic’, in the sense of an unavoidable source: ‘Mental Hygiene as an International Movement’ by Matthew Thomson, included in a book on international health organisations and movements in the interwar period, published by Paul Weindling.Footnote 13 The content of Thomson’s text mainly addresses three issues:
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a. The contrast between the secular and promotion-oriented American model and the medical-clinical model that predominated in Europe.
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b. The importance of considering the local context and adopting an ‘ecological’ perspective.
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c. In connection with the first point, the existence of ‘non-American channels of influence’, with at least two institutional reference models within the international mental hygiene movement.
In other words, despite certain inconsistencies and simplifications that will be pointed out later, Thomson’s work began to highlight the complex array of issues that must be considered when thinking about the history of the international mental hygiene movement.
Some more recent publications provide valuable contributions to renewing historical studies on the international mental hygiene movement. On the one hand, Psycho-Politics between the World Wars by David Freis examines the history of psychiatry in Germany, Austria, and Switzerland during the 1920s and 1930s.Footnote 14 Although his arguments concerning the international dimensions of the mental hygiene movement may be debatable, as will be discussed later, this work is an invaluable resource for tracing the development of local mental hygiene organisations in Central Europe by the mid-1920s.
On the other hand, the book edited by Ricardo Campos and Mariano Ruperthuz, titled Mental Hygiene, Psychiatry and Society in Ibero-America (1920–1960), aimed to position the region within the global history of mental hygiene, a field traditionally dominated by the USA and France. In later works, Ruperthuz has published studies dedicated to analysing the reception of North American and European mental hygienists’ theories and practices in Latin America.Footnote 15
Finally, in May 2024, Social History of Medicine published a special issue aiming to outline the history of mental hygiene in Europe. In the introduction to this dossier, written by Grégory Dufaud, Nicolas Henckes and Marianna Scarfone, the authors – far from seeking to extend traditional narratives – aimed to demonstrate ‘the plasticity of mental hygiene as a movement and a doctrine and the role of international transfers of ideas, models and practices in shaping its transformation at the global level’.Footnote 16 Rather than portraying a unified and homogeneous regional landscape, the authors emphasise the challenges of identifying a cohesive narrative within the diverse socio-political contexts of Italy, Spain, France, and beyond.
It is along the path opened by these works that the project of an off-centred history can be inserted. This proposal does not claim any kind of originality, and many connections can certainly be found with the models proposed by international, transnational, global, post-colonial histories, or even with the polycentric history proposed by Kurt Danziger.Footnote 17 An off-centred history refers mainly to the idea of a process or development that does not have an origin or a more or less clearly defined centre, from which a subsequent progressive process or path of more or less uniform and homogeneous characteristics was initiated. It is important to consider this starting point since, although recurrent storiesFootnote 18 or Whig-type stories are a model that has long been discredited, they still have their adherents and avid consumers, especially in professional fields such as psychology, psychiatry, and psychoanalysis.
But neither is it the goal of an off-centred history of the international mental hygiene movement to follow a reverse trajectory of ‘retroactive’ or Whig-type histories. In this sense, a first task is not to presuppose the meaning of a term such as ‘international’, but to restore its problematic character. Indeed, far from having a pristine and crystalline meaning and value in different geographies and/or periods, the international can, for example, be thought of in a broad sense, close to the regional or subregional (Europe, Asia, South America), in a more diffuse or imprecise sense, almost as a synonym for global or worldwide, but also in a much more restricted way, to refer to two or three nations or states. In other words, it is proposed to consider the ‘international’ as an open concept, in the sense given to it by the French sociologist Pierre Bourdieu.Footnote 19 Thus, an important question in the framework of a historical research on the international mental hygiene movement would be to ask what meaning or meanings and also what relevance was given to the international in various geographies and times, rather than presupposing that these meanings and relevance would be identical for all participating agents.
On the other hand, in the field of the history of science, there is often a tendency to think in polar terms and to consider the international either in terms of consensus, pacts, and harmonious connections or as a space of conflicts and tensions. In studying the international mental hygiene movement, it is essential to move beyond this Manichaean perspective and to consider both aspects at different levels, including their simultaneity and fluctuations – as will be demonstrated in the following sections. In other words, rather than presenting the gradual imposition of a hegemonic paradigm on a global scale, it is necessary to acknowledge the impact of local traditions, resistance, and conflicts, as well as agreements and consensus.Footnote 20
In this regard, the following discussion aims to demonstrate – while expanding upon certain issues already noted – that the early organisation of mental hygiene in the USA did not initially embrace an internationalist perspective, but was instead primarily oriented towards national- and state-level concerns. This will allow for an initial contrast with the European context, particularly the French case, and subsequently with the early development of mental hygiene in Latin America, which gave rise to projects, tensions, and even rejections grounded in local or regional considerations. The aim of this analysis was not to marginalise Beers or to diminish the significance of North American contributions to mental hygiene, but to reassess their place within the wider dynamics of the international mental hygiene movement. This approach offers an original perspective on more established historiographical narratives by shifting the interpretative focus from foundational and heroic accounts to a plural, situated, and contested reconstruction of the movement – one that problematises often naturalised notions such as the ‘international’.
The beginnings of a mental hygiene movement in the USA (1908–1918)
My viewpoint is that of the layman; my special interest is that of one whose privilege it was to plan and organize, with the help of many representative men and women, the first national and state agencies of their kind, namely, the National Committee and the Connecticut Society for Mental Hygiene.Footnote 21
This story has already been told and may be familiar. In fact, as mentioned above, the traditional or hegemonic accounts of mental hygiene concentrate almost exclusively on it. However, it is necessary to take up here at least its main milestones, mainly based on the aforementioned research by Norman Dain, Gerald Grob, and on some documentary sources.Footnote 22
In the mid-1900s, a young American man named Clifford Beers, from a well-off family in New Haven (Connecticut) and a graduate of Yale University, was admitted to Stamford Hall after a suicide attempt. Three years later, after being transferred to various psychiatric institutions, he was discharged. This experience led Beers to conceive a book aimed at narrating his ordeal and making the state of psychiatric care visible from a patient’s perspective, which would make it possible to initiate a reform movement.
In 1905, he began writing the draft of what, following the advice of philanthropist and lawyer Joseph Choate (1832–1917), would be an autobiography or, according to Beers himself, an autobiography and a biography at the same time. In 1906, he met the prestigious philosopher and psychologist William James (1842–1910) in Boston, and shortly thereafter, he sent him a draft of his book to receive his observations and feedback. This marked the beginning of an intense exchange in the form of correspondence and interviews, and James eventually became one of his main supporters: he authorised Beers to use one of his letters as a preface and sent a recommendation to his publisher to release the book.Footnote 23
Additionally, Beers wanted to have the endorsement of physicians and psychiatrists so that his reformist proposal could receive support from private funds. He then sent the manuscript to various professionals, whose sometimes fierce criticisms prompted the revision and rewriting of different passages of the book. It was the psychiatrist and reformer Stewart Paton (1865–1942) who not only co-operated with Beers, but also recommended him to contact Adolf Meyer (1866–1950), a prestigious neurologist of Swiss origin, disciple of the entomologist and psychiatrist Auguste Forel (1848–1931), who had emigrated to the USA in the 1890s and who at that time was the director of the Psychiatric Institute of the State Hospitals (New York).Footnote 24 In addition, Meyer was considerably close to the so-called Boston School, especially to William James, on whose recommendation he read Beers’ manuscript in September 1907. After several personal meetings and an extensive epistolary exchange, a close collaboration was established between the two, to the point that Beers’ own biographer describes Meyer as a ‘coworker in founding the reform movement’.Footnote 25 Beers introduced numerous modifications to moderate various aspects of the text and to qualify some passages considered to be groundlessly hypercritical.
From an extensive list of possible titles, among which Beers’ favourite was Reason Triumphant, A Mind That Found Itself was selected for the book that was published in March 1908. Despite exceeding 300 pages – a length uncommon for best-sellers – the book gained immediate notoriety and, a few years later, considerable publishing success. This launched Beers’ proposed reform movement, which initially took the form of a National Society for the Improvement of Conditions Among the Insane.Footnote 26
An antecedent to such an institution was the National Association for the Protection of the Insane and the Prevention of Insanity, an organisation that brought together laymen and professionals, founded in Cleveland (Ohio) on 1 July 1880, and presided over by Hervey Backus Wilbur (1820–1883), a physician who had trained in Europe with Édouard Séguin and had been the first superintendent of the State Asylum For Idiots in Syracuse. However, that organisation did not last long: without a solid financial base, the conflicts between lay people and professionals, and the death and retirement of its key figures caused the institution to disappear before achieving any practical accomplishments.
Beyond this ephemeral institution, Beers’ project did not have any local precedents and, by the early twentieth century, national health organisations in the USA were still scarce and precarious.
In the light of the situation, and drawing upon suggestions outlined by Meyer in his text To Whom It May Concern, along with the counsel of New York journalist and reform advocate George McAneny (1869–1953), Beers revised his initial proposal. Rather than concentrating solely on the reform of welfare institutions, the organisation’s mission was redefined to focus on fostering mental hygiene through the promotion of healthier lifestyles, the prevention of psychological disorders, and the effective management of those conditions that could not be avoided. On the other hand, instead of a nationwide movement, Beers agreed to found an institution at the state level, which could serve as a model for similar institutions that would later be the basis for a national organisation. Since the best conditions for launching this project were present in his hometown, Beers succeeded in establishing the Connecticut Society for Mental Hygiene on 6 May 1908, which initially consisted of thirteen members. One of the first issues dealt with by this institution, following the lines outlined by Meyer, was aftercare – to such an extent that Beers went so far as to state that ‘one may well consider the Connecticut Society for Mental Hygiene as being a large Committee for After-Care and Prevention, with a membership of several hundred representative citizens’.Footnote 27
The initial phase of the mental hygiene movement in the USA was shaped by both collaboration and conflict between Clifford Beers and Adolf Meyer. While Beers ultimately agreed to cede institutional control to Meyer and other professionals, tensions emerged early on between the lay leadership that Beers sought to assert and the medical-psychiatric authority advocated by Meyer. More relevant for present purposes is Meyer’s view that Beers’ ambition to establish a national organisation was premature. Nevertheless, he agreed to participate in the founding of the NCMH in New York on 19 February 1909, adopting the structure of the National Child Labor Committee as a model.Footnote 28
Since its inception, the board of directors was composed of doctors. Both the president, Henry B. Favill, and the vice presidents, Charles P. Bancroft and William H. Welch, were doctors, as well as Adolf Meyer, who assumed the position of Chairman of the Executive Committee, which included some laypeople, such as Russell Henry Chittenden (1856–1945), William James, and social reformer Julia Lathrop (1858–1932).
Owing to its broad and inclusive (if not amorphous) scope and financial difficulties, the NCMH achieved little in its first three years. Tensions grew between Beers – seeking both to establish the committee and to secure personal income – and Meyer, who urged caution, favoured state-level action, and insisted leadership remain with physicians, distrusting Beers’ mental stability.
By April 1910, the relationship between the two was strained to the maximum, and when Beers proposed launching a campaign to raise funds to appoint a director and a secretary in December of that year, Meyer resigned from his position as chairman of the executive committee and from his membership at the NCMH.
By the end of 1911, generous donations from businessman Henry Phipps allowed to temporarily unblock some financial problems and to implement some of the NCMH’s activities. To fill the position left vacant by Adolf Meyer, Thomas Salmon (1876–1927) – a physician who initially specialised in bacteriology and later entered the field of psychiatry after meeting William Russell (1863–1951) at the Willard State Hospital – was appointed.Footnote 29 During the early years of Salmon’s tenure, the NCMH engaged primarily in statistical research, in various state psychiatric institutions, on mental pathologies and later on the ‘feebleminded’.Footnote 30 These initiatives allowed him to start counting on the support of the Rockefeller Foundation from 1915 onwards.
On the other hand, the NCMH fulfilled its informative and educational function through the publication of abstracts on legislation, an index of literature on mental hygiene, lists of institutions and professionals throughout the country, in addition to publishing articles in newspapers and presenting lectures that, since 1917, were published in its own organ of diffusion: Mental Hygiene.
This made it possible to position the NCMH as a reference in the field of psychiatry in the USA, although scarce financial resources remained an unavoidable problem to which Beers dedicated himself almost exclusively, having by then settled in New York and resigned from the Connecticut Society to focus entirely on the NCMH’s activities.
In 1917, to relieve Salmon’s work as Medical Director, funds were allocated to hire an assistant: Dr Frankwood W. Williams (1883–1936), who had served as executive director of the Massachusetts Society for Mental Hygiene. But, a year later, Salmon was enlisted in the army to participate in the Great War across the ocean, excelling in the treatment of the so-called war neuroses, shell shock or petits mentaux in Europe. During this period, the activity of the NCMH became polarised and drastically reduced, much to the chagrin of Beers who was not particularly interested in the war conflict.
But, by the end of the 1910s, Beers’ conflicts with the NCMH Executive Committee were becoming increasingly intense: to the controversies over the proper methods of fund-raising, an area previously monopolised by Beers, was added the appointment of Williams as Medical Director, to which Beers was fervently opposed, as he considered Williams’s status and prestige insufficient to attract financial support.
The expanded vision of mental hygiene that emerged at the end of the Great War, with a greater emphasis on the prevention and the consideration of psychological factors, was the basis for several projects that were implemented by the NCMH in the years immediately after the end of the war. The focus on children and their environment (family, school, etc.) was intensified and Child Guidance Clinics were established; greater standardisation was required in the classification of mental pathologies and deficiencies; the production of statistics was promoted, which finally went beyond the walls of psychiatric institutions and took alcoholism and syphilis as their object. Finally, a little later, in view of the need to increase the number of specialists, private funding was obtained for psychiatric training scholarships. These tasks, while cementing the prestige of the NCMH, also made its institutional structure more complex.Footnote 31
As this overview of the first decade of the NCMH’s operation shows, Beers’ work was focused exclusively on organising the mental hygiene movement at the local, state, and national levels. It was after the end of the Great War that the first mental hygiene institutions began to appear outside the USA and thus the movement began to acquire an international scale. The Canadian National Committee, often referred to as a mere extension or appendage of the NCMH, was the first such organisation. In fact, most sources or research indicate that it was co-founded by Clifford Beers and Dr Clarence Meredith Hincks (1885–1964), a Canadian physician concerned about the state of psychiatric care in his country based on his experience in the outpatient clinic of the Toronto General Hospital. Without discarding the close links that may have existed between the two organisations, some more recent sources and research seek to rescue the particularities of the CNCMH. In Hincks’ biography,Footnote 32 it is stated that it was during a visit to New York, seeking advice to undertake some reforms in his country, that a colleague recommended him to visit the NCMH group. Then, almost by chance, he met Clifford Beers and received from his hands a copy of A Mind That Found Itself. After reading the book, he met with the author again to extend the reach of the mental hygiene movement to the neighbouring country. Noting Beers’ enthusiasm, Hincks went to Toronto and secured the support of the renowned neurologist Colin K. Russel (1877–1956) and Sir William Peterson (1856–1921), head of McGill University. He was then able to procure the patronage of the Duke of Devonshire, Governor-General of Canada, which enabled Hincks to organise a tea in three different cities (Toronto, Quebec, and Montreal), during which Clifford Beers would give a presentation on his life and the work of the NCMH. The first meeting, which took place on 26 February 1918, in front of some 200 people, raised more than 20,000 dollars. Although the press, particularly The Globe and Mail considered that the CNCMH ‘was launched’ at that time, the foundation took place in Ottawa a few months later, on 26 April 1918. A provisional constitution was adopted, which provided that the staff would be divided into one-third physicians, one-third non-physicians, and the remaining one-third unspecified, and, from among more than a hundred members, its authorities were elected – Hincks being appointed Secretary and Associate Medical Director.Footnote 33
In addition, while an organising committee of the International Committee of Mental Hygiene was set up in 1919, Beers remained focused on the local scene in the years that followed. In fact, his enthusiasm for the international sphere would become increasingly dominant in the following years, partly in response to domestic setbacks (conflicts with physicians who had begun to take control of the NCMH) and a promising international context (the end of the Great War, growing interest in mental hygiene in Europe, and the emergence of local organisations).
To better understand this emphasis and to contextualise the subsequent internationalisation of the mental hygiene movement, it is essential to examine the European landscape and the significance attributed there to the NCMH, particularly to Beers. This issue will be examined in more detail below.
The beginnings of a mental hygiene organisation in Europe (1906–1927)
The National Committee’s success and the fame of A Mind That Found Itself, together with Salmon’s achievement abroad, had begun to spread the ideas of mental hygiene in England, France, and Canada.Footnote 34
This honor marks, as it were, the beginning of the international phase of Mr. Beers’s unusual career. Mr. Beers is at present on leave of absence from his office as Secretary of The National Committee for Mental Hygiene, and plans before many months to go to foreign countries to stimulate interest in existing mental hygiene organizations and in the formation of them where none exists.Footnote 35
Historical research on mental hygiene organisations outside North America is quantitatively scarce and very unevenly distributed.Footnote 36 Moreover, it has predominantly adopted a state or national perspective, focusing almost exclusively on local initiatives to establish mental hygiene institutions. In this sense, with the exception of the book on Ibero-America and the special issue of Social History of Medicine on the European region mentioned earlier, no research has been conducted so far that focuses specifically on the history of mental hygiene from a regional or global approach.Footnote 37
Its origins date back to the end of the 1910s, in the context of a Europe devastated not only by the consequences of the Great War but also by the yellow fever epidemic, and which was seeking to reorganise its health system. In 1918, the Medical society of the Seine asylums commissioned Dr Édouard Toulouse (1865–1947), a prestigious alienist who at the time was working at the asylum of Villejuif (Paris), to draw up a project for the reorganisation of the hospitalisation of the mentally ill. According to his own testimony, it was in this context that he became aware of the work carried out by Beers in the USA through his young collaborator Raoul Mourgue (1886–1950), which led him to propose the creation of a Committee of Mental Hygiene, composed of both physicians and public officials, to implement reforms that would place ‘the Asylums of the Seine at the forefront of the establishments of the great nations’.Footnote 38 On 12 April 1920, the Ministry of Hygiene, Assistance and Social Welfare approved the creation of this committee to study issues such as the prophylaxis of insanity, the reform of the care of alienated persons, and the selection of schools and professions, but it soon proved insufficient as a driving force for a mental hygiene movement at the local level and set out to strengthen its work by appealing to public opinion.Footnote 39 Then, following the model of other institutions linked to pathologies such as tuberculosis, during a meeting held on 8 December 1920 at the headquarters of the same Ministry of Hygiene, the Ligue française de prophylaxie et hygiène mentales [French League for Mental Prophylaxis and Hygiene, FLMH] was founded and, after discussing its statutes, proceeded to the election of its steering committee, whose main figures were the aforementioned Édouard Toulouse (President) and Georges Genil-Perrin (Secretary General).Footnote 40
His opera prima, and certainly his magnum opus, was the inauguration of a Mental Prophylaxis Service at the Asile Clinique , a Paris asylum directed by Toulouse. This Service was opened in June 1922 and sought to solve the problem of assisting patients whose pathology did not fit the category of alienated and, therefore, were not covered by the Law on the Insane of 30 June 1838.Footnote 41 Two years later, this Service was renamed Hôpital Henri -Rousselle in homage to the general counsellor of the Seine who had pushed the project from the beginning.
These references allow us to appreciate some notable differences with respect to the North American organisation of mental hygiene. On the one hand, its main referents and promoters were two prestigious alienist physicians, unlike the clearly lay profile of Clifford Beers. However, this is not enough to distinguish between two exclusive institutional models, a lay and promotion-oriented one (North American) and a clinical-psychiatric one (French) as suggested by ThomsonFootnote 42 since, as shown above, medical professionals had a decisive participation in the direction of the NCHM from its beginnings and, in the case of the FLMH, its purpose was strongly articulated with public promotion and diffusion.
However, this medical-psychiatric interference, far from implying similar institutional models, does not eclipse what is arguably a more consequential difference between the two organisations: their respective sources of funding. In the case of the NCMH, Beers was a central figure in seeking and obtaining private funds, a task to which he devoted himself almost exclusively for more than two decades. The FLMH, meanwhile, had a close relationship with the French state, from which it obtained numerous subsidies, as shown in the Bulletin Municipal Officiel de la Ville de Paris. Footnote 43
But, beyond these similarities and differences in their organisation, the relations between the FLMH and the NCMH were marked almost from the beginning by tensions. Indeed, after achieving its first local victory with the creation of the Mental Prophylaxis Service, the FLMH quickly sought a place on the international scene, thereby entering into a more or less explicit rivalry with its American counterparts.Footnote 44
On 13 October 1921, Toulouse proposed to the FLMH board the organisation of an International Congress on Mental Hygiene,Footnote 45 later announced in L’Informateur des aliénistes et des neurologistes, directed by André Antheaume, recognised French alienist and president of the promotion committee of the FLMH. Backed by a distinguished committee, including the President of the French Republic, the event was aimed at professionals across medicine, education, industry, and sociology. In March 1922, its dates were confirmed (1–4 June) ‘with the agreement of all similar organizations abroad’,Footnote 46 framed as a response to the global emergence of mental hygiene organisations inspired by the USA and the need to establish a general doctrine that could be adapted to the local context of each country.Footnote 47
However, in April 1922, André Antheaume informed the FLMH that the American organising committee had requested the removal of the term ‘international’ from the event’s title. The French reluctantly agreed, renaming it the Paris Mental Hygiene Congress and revising its aims accordingly.Footnote 48
Despite this, the Congress was highly successful, attracting participants from twenty-four countries across four continents. Its expanded programme reflected strong domestic and international interest. In this respect, Toulouse was right when he affirmed, a year later, that the Paris Congress ‘although not officially, has in fact been international’.Footnote 49
Now, the conflict that arose from this frustrated International Congress, revealing the symbolic and strategic value both the Americans and French attached to the term ‘international’ within the mental hygiene movement, was the first of a series of confrontations and tensions. It is perhaps no coincidence that, in this context, Clifford Beers convened a second meeting of the organising committee of the International Committee, held on 11 December 1922 in New York, at which Dr Auguste Ley (1873–1956), president of the Ligue Nationale Belge d’Hygiène Mentale [Belgian National League for Mental Hygiene], founded in 1921, participated.Footnote 50 It was then that Beers decided to accept the invitation to visit several European cities. Thus, began what some would characterise as his ‘evangelising task’ on the old continent or, to use the metaphor employed by Dain, it was then that Beers began to plant the seeds that would sprout in Europe during the 1920s.Footnote 51
The news of Beers’ trip, which would include visits to London,Footnote 52 Paris, and Brussels, reached the old continent first-hand through Auguste Ley. Once back in Europe, Ley relayed the information to his French colleagues during the FLMH session of 15 February 1923. He announced that he had communicated with various European colleagues, emphasising that the Belgians and the French – whom he regarded as the leaders of the movement in Europe – had to reach out to the German representatives. As he explained, ‘in the US, it may not be well understood that an international movement can be reconciled with the exclusion of certain nations’.Footnote 53 The responsibility of contacting German colleagues was assigned to Genil-Perrin, who had already assumed this responsibility as Secretary General of the Mental Hygiene Congress in Paris. He was even recommended to ask the opinion of the Ministry of Foreign Affairs on questions that might be problematic from a diplomatic point of view.
This reveals yet another episode of international conflict, this time within the regional arena, highlighting the impact on the scientific field of the relations between the French and German nations, which, particularly after the Franco-Prussian War (1870–1871), escalated in their conflictive nature during the first half of the twentieth century.
Finally, in May 1923, Beers began his ‘European tour’ in Belgium, where he visited the famous community of Gheel and met with Cardinal Mercier and King Albert. In Paris, he was greeted with a Solemn Assembly of the LFHM in the amphitheatre of the Sorbonne, which seems to have had a successful convocation of thousands of attendees.Footnote 54 There Beers addressed a brief speech in his native language to an audience that included, besides national and municipal public officials, representatives from various European countries (England, Belgium, Italy, Spain, Denmark, Norway, and Czechoslovakia).
In addition, during his stay in Paris, Beers participated in a meeting, which, thanks to the archives of the Italian psychiatrist Giulio Ferrari (1868–1932), could be dated 28 May 1923, and which took place in the private home of the aforementioned André Antheaume. It was a ‘preparatory international conference’, as Genil-Perrin himself identified it five years later, to organise the participation of the representatives of the European continent in the first international congress to be held the following year. It is relevant to highlight two issues regarding the consequences of this meeting: On the one hand, in the presence of Beers and representatives of numerous European countries, it was agreed to entrust Genil-Perrin with the promotion in Europe; on the other hand, many of the European delegates present during the meeting succeeded in promoting multiple institutions in their respective countries.Footnote 55
One could then summarise the situation of the mental hygiene movement in Europe around the mid-1920s as follows: After the ‘international’ Congress in 1922, organised by the FLMH, and the visit of Beers in 1923, institutions began to emerge in the European region, as was the case in Italy (1924), Germany (1925), and Spain (1926)Footnote 56; on the other hand, news came from the USA that the International Congress was repeatedly postponed, mainly due to economic issues; finally, to the tensions that took place after the Paris Congress regarding the use of the term ‘international’, other conflictive scenarios began to be added, for example, between the French and the Germans. In this framework, the FLMH began to simultaneously promote two different projects of supranational organisation.
At a board meeting on 1 April 1926, the creation of a Latin Union of Mental Hygiene Leagues – as a potential regional section of the International Committee – was proposed with notable enthusiasm, while the idea of a European section was raised more tepidly. Shortly after, Édouard Toulouse informed Giulio Ferrari, by then already president of the Lega italiana di igiene e profilassi mentale [Italian League of Mental Hygiene and Prophylaxis], of these proposals, highlighting the contributions of Latin leagues in Europe and South America, without providing further details.Footnote 57 He suggested uniting leagues from nations with ‘racial affinities’ or shared needs in mental hygiene, invoking a civilisational rationale that echoed earlier organisational models and would later underpin the concept of a pan-Latin alliance.Footnote 58
The relevance initially given to this proposal allows us to assume that, given the geopolitical landscape, the French considered this mode of organisation less conflictive and more convenient. This seems to become evident when Toulouse, in the same letter, invites Ferrari to a European Conference of Mental Hygiene that would bring together European delegates to the First International Congress of Mental Hygiene, taking care to make it clear that German and Russian representatives would also be invited.Footnote 59
However, the fate of the two projects turned out to be very different. In the case of the Latin or pan-Latin organisation, although European and Latin conferences on mental hygiene were planned for July 1928, they were postponed for the following year, and although this event had different names, as will be seen below, none of them recovered the Latin key, which was later abandoned.
On the other hand, the development of a regional European structure within the mental hygiene movement took a distinct path, marked by key events such as the Meeting of European Members of the Organizing Committee, held in Paris on 2 June 1927. Attended by twenty-four delegates from thirteen countries, the meeting revealed diplomatic tensions – most notably, the French omission of a German invitation, which Beers rectified, thereby positioning himself as a neutral mediator between rival factions. In this way, the ‘American apostle’ came to occupy a prominent position not only as a shared point of reference but also as a mediator amid the conflict between different factions, particularly the Germans and the French. In other words, beyond his role in organising the mental hygiene movement in the USA, Beers came to function within the European regional sphere as a neutral, external figure, one to whom leadership could be consensually entrusted, and who, despite ongoing conflicts, was able to bring together opposing groups.
A subsequent European conference was convened in Paris on 3 June 1929, under various titles – including the European Conference of Psychiatry and Mental Hygiene, the European International Conference of Prophylaxis and Mental Hygiene, and simply the International Conference of Mental Hygiene. The event brought together prominent figures such as Toulouse, Ley, Ferrari, and Robert Sommer (1864–1937), a German psychiatrist and founder of the Deutschen Verband für Psychohygiene [German Association for Mental Hygiene],Footnote 60 alongside delegates from Belgium, Czechoslovakia, Denmark, England, Germany, Italy, Lithuania, Spain, Sweden, and Switzerland. While the principal aim of the meeting was to co-ordinate European participation in the forthcoming 1930 Washington Congress, the programme also featured scholarly presentations by Sommer, Toulouse and Dupuy, and Ley. Additionally, a proposal – postponed for future consideration – was made to formalise the regular European meetings that had taken place intermittently since 1923.Footnote 61
Mental hygiene in Latin America (1922–1929)
The previous sections have addressed the development of the international mental hygiene movement, focusing on the USA and Europe, with particular attention to the FLMH and the early stages of a regional organisation in Europe. In this section, the aim is to elaborate, in very general terms, the deployment of this movement in latitudes far from these centres of intellectual and scientific production. More precisely, it is of interest here to present an overview of the diffusion of mental hygiene in Latin America, highlighting the cases of Brazil and, especially, Argentina.Footnote 62 This topic has not been investigated to date and, far from presenting an exhaustive panorama, we are interested in pointing out some points that allow us to locate the meaning and relevance of the international movement for local institutions and some proposals for regional organisation.Footnote 63
For this purpose, it is necessary to take into account, on the one hand, that most of the incipient Latin American states had adopted, since the end of the nineteenth century, a policy openly favourable to immigration, especially with respect to immigration from Europe. The population of Latin America doubled in the second half of the nineteenth century and it is estimated that between 1870 and 1930, some thirteen million Europeans, mostly coming from Italy and Spain, entered the region. Although the impact was general, the countries most affected by this sudden and abundant wave of immigration were Argentina, Brazil, Uruguay, and Cuba.Footnote 64 In all cases these were young nations, in the process of state organisation and with a very low proportion of professionals, so the massive arrival of immigrants introduced considerable changes in the regional population (especially in the cities), which had an impact on the health situation, as shown by the epidemics of cholera and yellow fever, which facilitated the spread of the hygienist paradigm and began to cement the prestige of physicians.
On the other hand, statistics began to show considerable increases in crime and insanity rates, which were quickly associated with immigration, and it became pressing to set up the first institutions of confinement (prisons, penitentiaries, asylums and psychiatric hospitals) and to have tools of analysis and intervention that, with a strong imprint of the inherited-degenerationist paradigm of positivist roots and inspired almost exclusively by European models, especially French.Footnote 65 Indeed, partly due to its colonial past and also to its poor academic and welfare organisation, the ‘aristocratic’, professional and intellectual strata of the region looked mainly to Europe. In many Latin American countries, travelling to European academic centres to specialise with the great masters of France or Germany was a ritual that brought recognition and prestige for decades.
In this sense, it is interesting to show that the organisation of mental hygiene in Latin America cannot be understood simply in terms of ‘cultural imperialism’ as proposed by Thomson.Footnote 66 Indeed, far from merely extending the North American or French agenda at the international level towards the 1920s, it can only be understood from its articulation with a past and particular problems at both regional and local levels.
In this sense, although the promotion of the mental hygiene paradigm in Latin America, as in the USA and Europe, was headed by alienist psychiatrists who sought to introduce reforms in the assistance system, it should be taken into account that, in general terms, psychiatry was a field with little prestige within medicine. At the regional level, psychiatrists did not even have their own scientific societies until the 1920s (and even then, the organisations they founded were subsumed under neurology), nor did they have specific academic training until about the 1940s.
This allows us to understand that some Latin American figures sought to integrate themselves very early on, as early as the beginning of the twentieth century, in international psychiatric events and organisations in order to gain recognition or increase their reputation at the local level.
The first phase of mental hygiene in Brazil (1923–1928)
In the case of Brazil, a first figure to highlight is the psychiatrist Juliano Moreira (1873–1933),Footnote 67 who was already in regular contact with some European colleagues since the beginning of the twentieth century and had early contact with the FLMH. In March 1922, he sent a letter to this institution, which was then published in the Bulletin de la Ligue d’Hygiène Mentale and led to his being invited to participate in the Congress of Mental Hygiene in Paris (1–4 June 1922) to give a presentation on the care of alienated persons in Rio de Janeiro. Although Moreira was unable to attend, Dr Paolo de Figueiredo Parreiras Horta (1884–1961) was present at the event as a representative of the Brazilian Government.
In addition, L’informateur des aliénistes et des neurologistes published a laudatory review of a text by Moreira on the directives of mental hygiene in Brazil and spread the news about the well-deserved homage he received from the Brazilian Society of Neurology, Psychiatry and Legal Medicine in a ceremony held on 26 March 1922 to celebrate the twentieth anniversary as director of the Medical-Legal Assistance of the Alienated. It was also reported that, at the same meeting, the psychiatrist Gustavo Kohler Riedel (1887–1934)Footnote 68 announced the imminent creation of a Brazilian League for Mental Hygiene.
At the same time, Brazilian mental hygienists were beginning to consolidate their ties across the ocean with the North Americans. A Brazilian psychiatrist, representing Riedel, attended the aforementioned meeting of the organising committee of the International Committee of Mental Hygiene, held at the Yale Club (New York) on 11 December 1922. There he stated that Beers was considered in Brazil as the direct successor of French alienist Philippe Pinel and that all of Latin America was closely following the effort in pursuit of mental hygiene. At that event, Beers himself proposed to include Dr Riedel, as a representative of a local mental hygiene institution in formation, as a member of the organising committee of the first International Congress of Mental Hygiene.Footnote 69 Thus, through this Brazilian psychiatrist, Latin America was very early in the international mental hygiene movement, even before a formal regional chapter had been established.
It was a few days later that the BLMH was finally founded, which, by decree 4778, was declared an institution of public utility on 27 December 1923 and received notable subsidies from both the national and municipal governments.Footnote 70 Its first central executive committee was monopolised by alienist physicians: the aforementioned Gustavo Kohler Riedel (President), Dr Plinio Olinto (Vice-President), and Ernani Lopes (General Secretary).
According to Freire Costa, between 1923 and 1925, the BLMH followed the orientation that Riedel had given it, that is, to seek to improve the care of the sick.Footnote 71 However, already from its original statutes, a eugenic perspective was incorporated, which was embodied in projects aimed at prophylaxis and education of individuals ‘acting in conjunction with the federal, state and municipal public authorities’, as stated in the second article of the statutes of the Brazilian League.Footnote 72
In addition, in 1925, the Archivos Brasileiros de Higiene Mental, the official body of the Liga, began to be published, and in 1926, promoted by Antônio Carlos Pacheco e Silva, a branch of the BLMH, the Liga Paulista de Higiene Mental, was inaugurated in the city of São Paulo, which later published the Arquivos Paulistas de Higiene Mental.
Strikingly, in the pages of these journals, there was little room for international topics, with the notable exception of the reviews section and some news. A subjet that came to occupy a permanent section in the Archivos Brasileiros, and which attracted preferential attention from both local Leagues, was alcoholism, due to its association with degeneration.Footnote 73
By the second half of the 1920s, the BLMH entered an administrative and financial crisis following Riedel’s resignation as president. Moreover, as effects of economic ups and downs, in 1926 it ceased to receive the national state subsidy and the municipal subsidy was considerably reduced. The Archivos suspended its publication after publishing a couple of issues.Footnote 74
Two years later, with a more promising economic and political panorama, the BLMH reformed its statutes, in which a greater relevance of the preventive intervention of psychiatrists in the school, professional, and social spheres becomes notorious, relying on the notion of eugenics. According to Freire Costa, this notion ‘guaranteed “scientifically” the invasion of the social field by mental hygiene’.Footnote 75 This reactivation marked the beginning of a new phase in the history of the BLMH, presided over by Ernani Lopes (1885–1969) and with Julio Pires Porto Carrero (1887–1936) as vice president and Mirandolino Caldas as secretary general, which was preparing to attend the next International Congress with the largest Latin American delegation.
The beginnings of mental hygiene in Argentina (1922–1930)
In the case of Argentina, although there was a relatively contemporary dissemination to that of Brazil, the process of institutionalisation of mental hygiene was more complex and extensive.
The first promoter at the local level was Víctor Delfino (1883–1941), founder of a short-lived Argentine Eugenics Society and editor-in-chief of La Semana Médica, one of the principal journals of local physicians, in whose pages he disseminated the activities of the FLMH through at least half a dozen articles and news items.Footnote 76
Around the same time, the Italian psychiatrist Lanfranco Ciampi (1885–1962), a disciple of the prestigious Sante De Sanctis and recognised for his pioneering work in the area of child psychiatry, arrived in Buenos Aires. Ciampi began to disseminate locally some innovative proposals of the asylum device from some articles he published in local psychiatric and legal medicine journals as well as from his position as director of Clínica Psicopedagógica [Psychopedagogic Clinic]. In this journal, the first local project for the creation of dispensaries and psychiatric outpatient clinics was published, as well as the first proposal to connect with the international mental hygiene movement after the Congress held in Paris the previous year and the recent reforms carried out in Brazil in tune with the foundation of the LBHM.Footnote 77 The author of that text was the Director of the Hospicio de las Mercedes , one of the main institutions of psychiatric assistance in Argentina, and justified the value of the project as a concrete achievement to be presented at the International Congress of Mental Hygiene, initially planned for April 1924.
From these early texts some topics are introduced that will become common in the literature on local mental hygiene: the need to distinguish between acute (curable) and chronic (incurable or long evolution) psychiatric patients and to have the respective establishments for their care (open psychiatric hospitals or urban asylums and closed hospitals or asylums); the need to create outpatient clinics in general hospitals for the care of neuropaths or similar states (neurasthenic, psychasthenic, hysterical, hypochondriacs, mild cyclothymics) as well as to train social workers, following the model of female visitors in the case of tuberculosis patients.
In addition, local journals reproduced some articles by Latin American authors that took up and/or expanded on these topics – for example, the directives for mental hygiene by the aforementioned Juliano Moreira (1873–1933), and the synthetic programme that Peruvian psychiatrist Honorio Delgado proposed before the National Academy of Medicine to institutionalise mental hygiene in Peru.Footnote 78
However, the diffusion of the mental hygiene paradigm met with strong local resistance, as evidenced by some contemporary interventions of the prestigious psychiatrist Arturo Ameghino (1869–1949).Footnote 79 His texts are an extension of the alienist and criminological literature of the nineteenth century, and take up themes such as the relationship of madness with civilisation and, especially, with immigration in the light of the threat of heredity and degeneration.Footnote 80 According to Ameghino, it would not be convenient in Argentina to apply the prophylaxis of insanity promoted by the mental hygiene movement, especially in Europe, through open services or dispensaries that sought mainly to solve the problem of overcrowding in asylums. Instead, this author argues that it is necessary to apply a model that he calls mental prophylaxis, social prophylaxis or preventive mental hygiene, whose pillars would be the expansion of the network of establishments available for the care of alienated persons throughout the country and, especially, ‘a strict and appropriate surveillance of immigration’ Footnote 81 not limited to visibly alienated individuals – a matter already covered by current legislation – but especially to the dissimulated, degenerate or mentally inferior. This would avoid what Ameghino considers to be the ‘original sin’ that Clifford Beers would have passed on to the rest of the mental hygiene institutions, by advocating the excessive release of ‘psicópatas’. In this sense, he argued for a programme of eugenics, ‘old science rebaptized and rejuvenated’ which applied ‘the laws governing the development of life, to the improvement of organisms in general and particularly that of the human species’. He even invoked zootechnics, which he defined as the older sister of eugenics, devoted to the elimination of the worst characteristics.Footnote 82
In summary, the interventions and proposals described so far can be considered, finally, as two different ways of approaching the problem of mental hygiene within the framework of a eugenic programme at the local level, revealing various considerations regarding the international context. Indeed, while Delfino, Ciampi and others, similar to what happened in Brazil, aimed to prolong an articulation between eugenics and the international model of mental hygiene, which had already been established in many nations of the world, Ameghino sought to move away from that model, which he considered inadequate for the local panorama, and to broaden or deepen the already existing establishments and resources.
A key moment of intersection between differing approaches to mental hygiene in Argentina emerged within the Society of Neurology and Psychiatry, which had been founded in 1921 and which occupied a central place in the proposals and debates related to mental hygiene in Argentina. During its session on 29 August 1924, Gonzalo Bosch (1885–1967) presented a proposal for scientific exchange with the USA and read a letter from Clifford Beers, inviting Argentine professionals to participate in the forthcoming International Congress of Mental Hygiene in New York and to establish a national branch of the International League.Footnote 83 Beers had entrusted Bosch with promoting this initiative locally. Bosch, in turn, advocated for a material contribution to strengthen ties with the American committee and enhance the international visibility of Argentine psychiatry.
Some members supported the proposal, including Fernando Gorriti and Arturo Mó, a collaborator of Bosch, who took care to point out that he had received a similar assignment from the FLMH in 1922 and regretted that the commission appointed by the Society to deal with that issue had never met. But Arturo Ameghino cautioned against aligning too closely with the Anglo-American model, advocating instead for a merely symbolic response. Finally, it was agreed to respond to the American and French committees through ‘simple moral support’,Footnote 84 a task that Bosch and Mó would be in charge of.
After the enthusiasm and appreciation for the international context demonstrated by some young local figures, and this unsuccessful proposal to join the international mental hygiene movement, this topic seems to have been discarded.
However, a few years later, a second stage of this history began and it is possible to appreciate a renewed interest in the institutionalisation of mental hygiene among Argentine psychiatrists.
In 1927, several papers were presented at the Society of Neurology and Psychiatry seeking to promote the institutionalisation of mental hygiene in Argentina following the example of the aforementioned Hôpital Henri-Rousselle and the FLMH model.Footnote 85 The creation of a Social League of Mental Hygiene was even proposed in 1928, whose statutes were explicitly inspired by the French League,Footnote 86 a project that was again opposed by Arturo Ameghino, then president of the Society of Neurology and Psychiatry.Footnote 87 Two years later, the National Department of Hygiene commissioned the psychiatrist Gregorio Bermann (1894–1972) to elaborate a preliminary project to create a special directorate for the care of alienated persons and mental hygiene, which he presented in December 1930 to the Society of Neurology and Psychiatry. But, by then, a military coup had imposed new national authorities and, in addition, since 6 December 1929, the Liga Argentina de Higiene Mental had been in operation under the impulse of the aforementioned Gonzalo Bosch, who was its president for almost two decades.Footnote 88
What factors enabled this proposal to succeed where earlier efforts to join the international mental hygiene movement had failed? In order to try to answer this question, it is important to take into consideration not only some figures and circumstances specific to the local psychiatric field, but also the international and especially the regional panorama.
Of course, the imminent celebration of the International Congress of Mental Hygiene, whose date had been fixed, after several postponements, for May 1930 in Washington, D.C., could have been an incentive for the sending of local delegates. But much more relevant in this history was the Latin American Conference of Neurology, Psychiatry and Legal Medicine, which was held in Argentina (1928) and Brazil (1930).Footnote 89 This event not only encouraged the creation of ‘open services’ based on the model of the work carried out by the FLMH and the Hôpital Henri-Rousselle, but also encouraged the creation of local mental hygiene organisations, as was the case not only in Argentina but also in Chile and Peru in 1931 and 1933, or the reactivation of the BLMH in 1928.
But this was not the first time that a regional event became a space of diffusion for mental hygiene in Latin America. Already during the Sixth Latin American Medical Congress (Cuba, 19–26 November 1922), the aforementioned Brazilian psychiatrist Gustavo Riedel had proposed the creation of a Latin American Committee of Mental and Nervous Hygiene, which would be composed of two representatives from each country of the region. The purpose of this Committee would be ‘to guide studies on the Etiology of Nervous and Mental Diseases’ and ‘on normal and morbid Psycho-physiology, in its applications to the various social activities’.Footnote 90 In this way, a Code of Prophylactic Resources for Nervous and Mental Disturbances would be made available to the governments of Latin America. This committee, or sub-committee, whose creation would have been presented to Beers shortly thereafter,Footnote 91 would meet on the occasion of each Latin American Medical Congress, whose next edition was to be held in 1925 in Mexico, but was postponed until 1930. Although it is probable that this organisation was never put into operation, this event shows that, in the case of Latin America, no direct external impulse from the North American or French mental hygiene organisations was necessary for the initiative of a regional organisation to emerge.
Closing: internationalism and centrality in the mental hygiene movement
Having outlined the early stages of mental hygiene organisation in the USA, Europe, and Latin America, this final section aims to provide a broader overview and draw some conclusions from the decentralised perspective advanced in this study.
It is often pointed out that the year 1930 was the peak of the international mental hygiene movement: twenty-two years after the creation of the Connecticut Society for Mental Hygiene, the first International Congress of Mental Hygiene brought together 3,042 participants from forty-five countries and the International Committee of Mental Hygiene was formed, which included twenty-nine nations.Footnote 92 However, less than ten per cent of the attendees came from abroad, which resulted in an overrepresentation of the USA in the leadership positions of the International Committee, with seventeen representatives on the Governing Board out of a total of thirty-two members.
On the other hand, if the history of the mental hygiene movement, as can be appreciated up to this point, did not unfold as a linear process of institutional integration into a steadily expanding international structure, its subsequent development seems rather to show a tendency towards the autonomous development of different nuclei. In this sense, the scenario following the First International Congress of Mental Hygiene and the context immediately prior to the Second World War (1939–1945) affected European and Latin American mental hygienists in very different ways.
In the old continent, the organisation of the Second International Congress, to be held in Paris with a date set for 1933 but which was postponed successively until July 1937, required a series of meetings that, from the outset – as archival documents show – went beyond organisational matters and sought to create a space for discussion and consensus on common issues among the countries of the region. This can already be seen in the first of a series of six meetings of European mental hygienists, which took place in Paris in 1932, with the presence of Beers during his third and last visit to Europe. According to the record published in La Prophylaxie Mentale, his only intervention during the event stressed the same topic that, ten years earlier, had already been brought to the attention of the French: the question of internationalism. Indeed, Beers requested that, in order to avoid confusion with the International Congress , the title of International Meeting be changed to European Meeting .Footnote 93 However, this time the concession was met with resistance and certain dilatory manoeuvres: Toulouse itself argued that there could be no confusion but that, to satisfy Beers, the executive commission would study his request and notify the decision to the mental hygiene leagues. Finally, Beers’ request was granted and during the subsequent iterations of the European Mental Hygiene Meeting – held in Rome, Brussels, London, Munich, and Lugano – a European Mental Hygiene Committee began to be planned.Footnote 94 But the gradual rise of Nazism, the Spanish Civil War and, finally, the outbreak of the Second World War brought all these initiatives to a halt and paralysed the European mental hygiene movement in 1939.Footnote 95
In contrast, the 1930s offered more favourable conditions for the development of mental hygiene in Latin America. While the frustrated initiative of a Latin American Committee of Mental Hygiene in 1922 illustrates the early interest of mental hygienists in the region to strengthen ties, the Latin American Conferences of Neurology, Psychiatry and Legal Medicine of the late 1920s served as a precursor to project various organisational proposals that were later formulated.
This was the case of the Inter-American Conference on Mental Hygiene held in Brazil in October 1935, which brought together representatives from eleven states of the American continent (USA, Argentina, Brazil, Canada, Chile, Cuba, Dominican Republic, Guatemala, Mexico, Peru, and Puerto Rico).Footnote 96 This event was originally planned to bring together South American neuro-hygienists in view of the Second International Congress of Mental Hygiene (Paris, 1937), but it was also considered as a space to debate ‘the problems of mental hygiene of particular interest to the countries of the New World’.Footnote 97 As shown by its statute, ‘strictly modeled on the Statute of the Latin American Conferences of Neurology, Psychiatry and Legal Medicine’,Footnote 98 it explicitly aimed to include the USA, without assigning it any privileged status within this organisation, which hoped to establish itself as a space for periodic meetings.Footnote 99
Even the subsequent context of the Second World War posed a particular situation for the Latin American region which, away from the war scenario, was in a position to continue to develop both locally, regionally, and internationally. For example, initial preparations were made for a Third International Congress of Mental Hygiene, initially intended to take place in Rio de Janeiro in 1940, or even a First Pan-American Congress of Mental Hygiene, to be held in Rio de Janeiro and Buenos Aires once the Second World War was over, with the aim of ‘facing the situation in which the world would be left after the war and taking measures in this respect’.Footnote 100 In this context, both Brazil and Argentina were emerging as regional leaders with a not inconsiderable potential, especially in the case of Brazil, to become a power capable of participating in global leadership. However, the post–Second World War context radically altered this landscape, and the ‘new’ mental health paradigm enveloped the mental hygiene movement and gave the triumphant Allied powers a temporary but far-reaching leadership on the global stage during the second half of the 1940s.Footnote 101
The overview presented in these pages demonstrates that the organisation of the mental hygiene movement in Europe was shaped by both internal and external tensions in connection with the USA, while also requiring Beers to act as a mediator. Furthermore, local initiatives in Latin America were not simply derivative of, or extensions of, the dominant models developed in the USA or France. Rather, their emergence and trajectory were propelled by dynamics rooted in local contexts and shaped by broader regional factors. It is therefore essential to adopt a historically grounded, decentralised perspective in order to analyse these processes in their full complexity.
In fact, from this perspective, and based on a review of various documents and research conducted thus far, the history of the international mental hygiene movement should trace its origins to the early twentieth century, prior to the publication of Clifford Beers’ A Mind That Found Itself, in order to address the significance of an event that warrants mention here: the International Congress for the Care of the Insane. Driven by the success of alternative forms of assistance to asylums, such as those implemented in Gheel (Belgium), it had its first edition in 1902 and met several times until the outbreak of the Great War put an end to its continuity. The relevance of this event for the subject addressed in this article focuses especially on the Second Congress (Milan, 26–30 September 1906), whose organisation was in the hands of the aforementioned Italian psychiatrist Giulio Cesare Ferrari.Footnote 102
At the first session of this event, the Zurich alienist Ludwig Frank (1874–1914) presented a Call for the foundation of an International Institute to establish and fight the causes of mental illnesses. To this end, together with a tentative programme of statistical research on heredity, alcoholism, and syphilis, he proposed the creation of an international committee that would promote the foundation of this International Institute.Footnote 103 In the ensuing discussion, despite some proposals to postpone or suggest alternativesFootnote 104, the Congress approved the creation of the Committee and the musician-composer Louis Lombard (1861–1927) offered to locate its headquarters in the Trevano Castle (Lugano, Switzerland), which he had recently acquired.
In addition to representatives from eighteen European countries, this international committee would also include representatives from other, somewhat more distant countries. For example, the prestigious physicians Domingo Cabred and José Ingenieros were appointed as representatives of Argentina; in the case of Brazil, its representative was the aforementioned Dr Juliano Moreira, future honorary president of the BLMH; and as North American representative, Adolf Meyer was appointed, who, two years later, was a central figure in the beginnings of the mental hygiene movement on the other side of the ocean.
In this way, it becomes possible to build a different genealogy, which in turn distances itself from the alternative version outlined by David Freis.Footnote 105 Indeed, this author proposes to understand the mental hygiene movement in Europe as the re-importation of a model whose original formulation comes from the Swiss psychiatrist Auguste Forel and which was disseminated in the USA through his disciple, Adolf Meyer. While this interpretation offers a different perspective on the history of mental hygiene in Europe, it remains somewhat simplistic. It effectively re-centres the history of the mental hygiene movement around a new figure, artificially revaluing his international contribution, while neglecting the significant events of 1902 and 1906 and failing to recognise the participation of the LFHM.
Now, this question, as well as multiple events, organisations, and figures that have been mentioned so far, open the way to multiple historical inquiries or even to microhistories. In this sense, rather than showing the concrete results of a historical inquiry or an established historical model or methodology, the aim here was to highlight a diverse and complex panorama, and to point out some of the multiple tasks pending to address the development of the mental hygiene movement on a global scale. Most importantly, this historical inquiry must move beyond the conception of an original core as its starting point, demonstrating how this notion has become an obstacle to adopting a perspective that, although seemingly paradoxical, must be decentralised.
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