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Hist. cienc. saude-Manguinhos vol.15 no.2 Rio de Janeiro Apr./June 2008
Torrent of madmen: the language of degeneration in Portuguese psychiatry at the close of the 19th century*
Professor of the Department of Anthropology/ Universidade de Coimbra. Rua do Arco da Traição. 3000-056 Coimbra - Portugal. firstname.lastname@example.org
The scope of this article is to show the importance of a highly naturalized model of human actions that, taking as its pivotal point a hereditary explanation, was widely used by Portuguese psychiatry at the close of the 19th century, in continuity with what was happening in the European context. 'Degeneration' was instituted as a species of chart, based on which experiences were classified and described with occasionally threatening contours for a certain conception of the social and political order. Various phenomena, nosologically described in differentiated forms, came to be integrated into the language of degeneration. Its expansive and supposed metatheoretical character became involved in its death throes, coming to be progressively replaced by another model, psychoanalysis.
Keywords: psychiatry; degeneration; psychoanalysis; Portugal; 19th century.
In this study, I merely propose to understand and explain the general reach of 'degeneration' among alienists of the period, among whom the personages of Miguel Bombarda, Júlio de Matos and Sobral Cid are prominent.
It seems to me to be relevant here to note (albeit in a very synthetic form) the context in which Portuguese psychiatry emerges and the work of these three people. The process of institutionalizing modern psychiatry (and the expression is pleonastic, since there is only psychiatry in modern times) effectively began in Portugal with the opening of the first hospital for the alienated in 1848, Rilhafoles. It was given greater impulse, however, with the personage of doctor António Maria de Sena (1845-1890), who was the first director of the second institution of its kind to emerge in Portugal, the Conde de Ferreira Hospital for the Alienated in Porto, inaugurated in 1883. Sena was responsible not only for the foundation of the Conde de Ferreira Hospital, but also the enactment in 1889 of the first Portuguese law to provide assistance to the mentally ill and the first statistical study of alienation in Portugal (Sena, 1884). Miguel Bombarda (1851-1910), a fervent republican, became, in turn, prominent for reforming the Rilhafoles Hospital, which would be named in his honor after his death. Bombarda was a courageous polemicist and responsible for the Rilhafoles Histology Laboratory in 1887. Júlio de Matos (1857-1923) entered the Conde de Ferreira Hospital as Sena's assistant in March 1883, when it opened. He assumed command of this institution in 1890, following the death of Sena. His appointment as alienist doctor of the Porto Medical-Legal Board occurred in 1899 (Fernandes, 1957, p.6-8). In 1911 he was appointed "medical director of Rilhafoles and was transferred from the Porto Medicine Faculty to the same position in Lisbon" (p.6)1, assuming the post left vacant upon the death of Miguel Bombarda, who was assassinated by a former patient of his in Rilhafoles on the eve of the republican revolution of October 5, 1910. José de Matos Sobral Cid (1877-1941), in turn, had been sent from Coimbra to Lisbon in 1911 where, together with the Lisbon Medicine Faculty, he assumed the duties of professor of the recently created chair of forensic psychiatry. After the death of Júlio de Matos, Cid began to lecture as the psychiatry chair head (into which forensic psychiatry had been merged) He was designated director of the Bombarda insane asylum in 1923. He exercised his duties there until the year of his death (Costa, 1941, p.3; Ilharco, 1981, p.6). His published medical-legal opinions all date from the period in which he was associated with the Lisbon Medicine Faculty and the Medical-Legal Board of the 1st district.
That moment in the history of Portuguese psychiatry (then emerging and undergoing consolidation) takes shape incorporating the uses of a particular language, the language of degeneration, even when it was fast losing general favor and its death throes became perceptible. We can delineate its influence in terms of vocabulary from a quote from Miguel Bombarda:
The inheritance of physiological gifts, the inheritance of multiple neuropathic forms, the transmission of psychiatric forms alternating among themselves or with the former, the intimate relationships of madness and criminality from the point of view of heredity, all this constitutes an enormous accumulation of proven facts, about which science has no doubt and whose mere exposition has filled volumes. The passing from parents to children of cerebral pathological states has been built up today to the stature of a body of scientific doctrine. Degenerations - be they progressive or regressive - encompass multiple states of cerebral anomaly, from genius forms to neuroses, madness and crime on to idiocy. And what's more, these connections are not recognized only après coup, after the manifestations, the acts, but are discovered in the individual at the time of birth by the anomalies in the form in which what are known as the physical stigmas of degeneration are constituted ... The evolutionary sequence presents alterations in organs and tissues, arrested development and defects of conformation, alterations that at bottom are true monstrosities. And just as there are teratological deviations in the skin, the bone skeleton, the cartilages , etc. - the stigmas - so are there in the cerebral organ - and therefore an abnormal psychology - insanity, criminality, hysteria, epilepsy, etc., etc., etc. (Bombarda, 1898, p.64-66)
"Etc., etc., etc.". What these prolonged ellipses make explicit is the enormous reach of a theory that spanned various disciplinary niches during the second half of the 19th century and whose scientific project was only be overturned in the first decades of the 20th century under the influence of other theoretical tableaus (psychoanalysis, for example), as well as social and political circumstances that deserve further continued reflection, despite the invaluable contributions of investigators, among whom Daniel Pick (1996)2 clearly stands out.
Degeneration was, then, a comprehensive model of abnormal psychology that, as far back as Bénédict Augustin Morel, took root in the strongly hereditary inflection of a regressive nature (Harris, 1989, p.51-79; Pick, 1996, p.44-59). A model based on the unquestionable fact for the psychiatry of the epoch that the morbid background accumulated from generation to generation and, when least expected, broke out, putting the reigning social and political fabric to the test.
There are several ways for us to understand the psychiatric and forensic meaning of this in light of the works of the Portuguese alienists contemplated in this study.
In 1884, in his pioneering Manual das doenças mentais, among the "predisposing causes" of insanity, Júlio de Matos points to an etiological factor of supreme importance, "heredity". Matos manifests here an extreme uneasiness with respect to the penetration that morbid inheritance could achieve in the populace, inheritances difficult to identify, even when not systematically and laboriously hidden from the eyes of the alienists by the families whose statements were essential to the establishment of individual clinical biographies (Matos, 1884, p.14). The reach of the degenerationist explanation was emphasized in the following terms:
Formerly, doctors only considered a case of insanity to be hereditary when there was an analogous illness in the parents of the alienated person; today the sphere of hereditary action tends to widen, embracing all the cases of alienation occurring in the descendents of the neuropaths, alcoholics and those affected by diatesic diseases. According to this outlook, the alienated person represents, not the necessary repetition of ancestral madness, but the last stage in a long series of intimate physical and psychological degenerations. (Matos, 1884, p.14, 15)
The 'degenerates' reveal their morbid background through a set of somatic and psychological characteristics that one must identify among the individuals of a population. The preventive dimension with which the Cosmopolis provides itself is also situated in the efficacy of this identification process (Toulmin, 1990, p.67-69), i.e., society regulated by the precepts of a science that it was urgent to construct. Matos enumerates such somatic and psychological indices, or stigmas, in his Manual:
Those predisposed by inheritance to mental alienation are distinguished in the eye of the experienced observer by readily appreciable organic and psychic characteristics.
Usually they are poorly shaped. Sometimes the cranial diameters are inferior to the average; at other times there is a disproportion between the cranium and the face. The asymmetry of this region, the defective implantation of the teeth, the irregular shape of the ears and anomalies in the genital organs ... are very common phenomena. Squinting and nervous tics ... sometimes appear ... The early childhood development of these beings is usually abnormal: they are late to talk and walk and often in teething.
From the psychical point of view, candidates for insanity also present clearly pathological features. They are eccentric, utopian, extravagant, vain and especially ... revoltingly egoistical. They insufficiently appreciate the notion of justice, they cause trouble wherever they live, they are choleric, lack perseverance or are stubborn and usually feel irresistible impulses that lead them to alcoholic abuses and the most abject licentiousness. At times they far surpass normal intelligence standards; however, their aptitudes are always exclusive and limited. Some are good poets, others good musicians or good painters, but none of them possess the malleability of spirit that an encyclopedic education demands and requires. (Matos, 1884, p.15, 16)
Hereditary predisposition appears as one of the key elements to understanding endemic mental insanity (whose reach and contours for the Portuguese case began to be delved into in the 1880s. The family was, in this sense, the basic observation and analysis unit for eventual pathologies and their trajectory in the community. Matos reflects on these abundantly, writing:
In the human species, as in all, the product of fertilization will reproduce, by the law of inheritance, the typical features of the progenitors. If they are perfect, the product must be so as well, but if they are representatives of a race in decadence or of a family in which there exists a hereditary stain, it is understood that the consanguinity of the unions will do nothing but accentuate the sinister features of the parentage in the fertilized product. (Matos, 1884, p.17)
What this alienist reveals in his accentuated degenerationist reading of mental insanity is the manifest connection between sex and blood that such an explanatory matrix seems to justify.
We may consider sex and blood to be the two poles of the degenerationist system. The regulation of sex through a "dispositive of sexuality", as Foucault (1994, p.79-133) refers to it, will insistently express itself through a vehement concern with blood. If, he writes (p.127), "the bourgeoisie's 'blood' was its sex", symmetrically, the sex of the bourgeoisie was also its blood. Only thus can we completely understand the notable observation that the "family is the broker of sexuality and alliance: it conveys the legal and juridical dimension to the dispositive of sexuality; and it conveys the economy of pleasure and intensity of sensations in the regime of alliances" (p.111).
The global or metatheoretical nature of the degenerationist model can be admitted in light of its extreme classificatory fluidity (encompassing a number of the most expressive classifications on the nosological trees then in use), and also in light of the recursivity that the scheme denoted between the normal and pathological categories. It begins with this last aspect. Bombarda tells us:
The degenerations are clear in their translation, because the facts that they encompass are brutally gross facts, with clear outlines that allow no doubts or hesitations. But, in fact, they are nothing more than the amplification, at times a caricature of normal things, because, fundamentally, there is nothing in pathological phenomena that does not exist in physiological phenomena. The energy of manifestation, the means of combination, etc., can be different, but the nature and essential features of both are exactly the same.
That is to say, from anthropological and psychiatric observation we can make the most legitimate deduction for normal psychology and say that the way the mind works depends, in part, on the cerebral organization inherited (Bombarda, 1898, p.68, 69)
However, this metatheory about the pathological (marked by the constant interstitial communication with the normal) retains a far more complex profile than it appeared to in the strictly hereditary emphasis.
It is important to ask ourselves about the understanding obtained from the notion of invoked heredity. It is interesting to verify if we are faced with a notion of heredity coined in Lamarckian territory, as Harris alleges (1989, p.65). This author reveals to us how the "domination attained by the theory of degeneration in the last part of the century can only be understood in the context of the French Lamarckian outlook regarding the inheritance and transformation of the species, an approximation that is opposed to the Darwinian emphasis on natural selection" (p.65). Be that as it may, and as Harris does not fail to add, "it is important to recognize that no one and only [therefore, essential] conception, be it 'Darwinian' or 'Lamarckian', can be offered" (p.65). Without wishing to go into greater detail, I must add, along with Harris, that an explicit and unquestionable appeal to chance or natural selection as the 'motor' of the evolutionary system can be detected (and the Portuguese case stands out in this regard) in any of the degenerationist analyses then current. On the contrary, the work of these alienist doctors seems to be concentrated on the efforts of the organism to adapt itself, purposely and directionally, to an environment in permanent change (p.67). In this regard, some of the Portuguese alienists (among whom Miguel Bombarda stands out) seemed to mimic their French peers, giving the environment, rather than natural selection, manifest vectoriality and creativity. This tableau of transformations can be understood through Bombarda:
A fertilized egg, having latent paternal qualities, may not present them later, because it was altered in its evolution, for example, due to an illness, or because another important factor, education, influenced it.
Mentality, and therefore the acts of man, does not, in fact, depend exclusively on the initial structure of the brain. Education, in the broadest sense, has a powerful impact on the way a man acts he as does and influences by acting on the base of the acts itself, that is, in the same cerebral organization, which thus must be considered, even anatomically, as a result of these two components - congenital state and educative actions. (Bombarda, 1898, p.69, 70)
And a little later on he points out the influence that the "French school" assumes in his thinking, contrasting it with the "Italian school":
Whether or not it has acted on the cerebral organization itself, there is no doubt that education has a great influence on the acts of individuals. This influence is so great that in criminology a school was founded, the French school, which considers the social factor as the most important, if not the only, agent in the facts of criminality, contrary to the Italian school, which sees the congenital organization as almost the only factor . (Bombarda, 1898, p.70, 71)
In a certain way, this interrelationship between soma and environment only accentuated the metatheoretical pretensions, because it intended to abolish the irremediable mind/body opposition, involving them in a single explanatory model. Such metatheoretical pretensions would also suggest a common background for the arborescent and forever volatile classificatory profusion. When we look at the nosological classifications of the period (in their theoretical and practical records), we understand the entire range of observation of Machado de Assis (a contemporary of Matos and Bombarda) in The alienist, when he tells us, through the words of doctor Simão Bacamarte, that madness is not in the end an "island", but a "continent".3 The degenerationist scheme was a way of comprehensively circumscribing the plethora of classifications in use. Note, for example, that the scheme included such disparate nosologies as 'moral madness' (which itself retained a relatively instable classificatory credential, distinguishing itself with a permanent ambiguity between pathology and immorality, madness and iniquity), 'epilepsy' or 'paranoia' (any one of these categories reveals an enormous semantic and semiological plasticity). The degenerationist scheme thus displayed its longitudinal ambitions (Berrios, Beer, 1999, p.324).
Bombarda, extending the range of the model, dares to detect in epilepsy its unsophisticated degenerative background. Questioning the border between the normal and the pathological, he writes:
Where can the ideally normal spirit, duly pondered in all of its faculties, with the exact quantum of volitional energies and commotive strengths, be found? What spirit does not shelter this or that modality that sets it apart from the norm in men?
All of these doubts, which even if they can sustain the proposition of minimal degenerations, break down completely when we examine epilepsy thoroughly. We are almost at the extreme opposite of the degenerated series. We find ourselves with the heaviest degrees of degenerative stigmatization; the facts that we encounter reveal themselves at the same time to be so deeply engrained and so widespread throughout the entire organism that there can be no hesitation; we find ourselves frankly in the terrain of abnormality. (Bombarda, 1896a, p.208)
What this nosology reveals, therefore, is the degenerationist constellation in action, capable of strengthening dislocations between the normal and pathological, which are incessant reinforcements of extensive social and forensic evaluations. Thus, for example, Bombarda (1896a) compares the epileptic with the moral madman, placing them at opposite extremes of an economy of passion, moving on to a set of appreciations on human nature and the effects of civilization on the essential condition of man:
The affections and passions of epileptics are always excessive ... . Unleashed, under the influence of an evil passion [the epileptic] is a wild beast.
The epileptic is thus passionate; here we are far from the moral madman, who is indifferent and an egoist. But in this passion there is always the evil aspect, which becomes incomparably more accentuated. Not because the two aspects, good and evil, which characteristically alternate, exist in him, but because it is the bad side that harms us most, because it is the bad sentiments that most violently and with the greatest loss to others that can manifest themselves, because in life the circumstances that can antagonize us are much more numerous than those that can favor us, and finally because human nature is before all else malicious and the epileptic can only exaggerate it.
There is a lot of civilization varnish, a lot of police polish on present day social life. Take away from man this light and artificial layer of benignancy and the savage breaks out. Facts every day attest to it. It is the crude laughter of those who witness a potentially disastrous fall. It is the sexual rage of mobs. It is the insult that offends the honest woman passing by. It is the persecution carried out against the weak, the crippled, the idiots, the aged when far from the eyes of the police. They are the bloody acts of crowds, it is the rage of carnage that they commit when freed from the protective restraint of police agents. And finally the violence of despotism, when the power encounters a defenseless, indifferent and decayed people.
The epileptic is a normal man from whom all the polish of civilization has been removed; he is the civilized man in whom the set of reflected notions, which are constituted by the respect for the rights of others and fear of the law, no longer have a voice in the domain of the conscience. (Bombarda, 1896a, p.217-219)
This rigorous anthropological pessimism will guide the reflection and forensic practice of the Portuguese alienists at the close of the century. The language of degeneration dominates their considerations regarding subjects that become caught up in the legal aspects of medical knowledge. For Bombarda, as well as Matos, criminal anthropology was not only be the vanguard science in the troubled times in which they lived - 'criminal anthropology is the science of our day", writes Bombarda (1896a, p.335) -, but also how a crime reveals a defective and fatally defective "individual organization" (p.336). Bombarda, despite his positional ambiguity between the French school and the Italian school (in A consciência e o livre arbítrio, published two years after his treatise on epilepsy, Bombarda seems closer to the positions of the first than the second), remains in essence the same:
Crime is a fatality of organization. There could be effective intervention of the mesological conditions that come to influence its manifestation. But the individual factor always stands up as the most powerful and the most necessary. The individualist theories can also differ on the way of looking at the criminal. But, if many sin by exclusion, if the crime is not only an epileptic or atavistic phenomenon, if it is not always the act of a moral madman, if, on the contrary, it can be all that and even more that the degeneration embraces, that which all bundle together to see in the criminal a sick person.
It is this fact, which has proven to be intractable, that sustains itself in positive science. This is shown by the study of a past in which crime, neurosis and madness are mixed, connected and confused. It is shown by the complex stigmatization that marks more indelibly the criminal than the branding iron of backward civilizations. A mental life that has freed itself of social ties and in its egoism has grasped the entire world for its exclusive pleasure also shows it. And finally, it is shown by the indocility of the criminal before all, absolutely all, educating influences.
Regeneration of the delinquent is the most amazing utopia of our times. (Bombarda, 1896a, p.336, 337)
What is important to point out is that the theory or model of degeneration would articulate, in its comprehensive movement, many of the nosologies then in vogue, among which moral madness and epilepsy stand out, but also 'paranoia', that locus classicus of all modern psychiatry.
Paranoia, which is an acquisition of psychiatric modernity (and the expression is pleonastic because there is only psychiatry in modernity), will have individual or collective expression. And when it inscribes itself not only in the individual body, but also in the collective body, it can be called 'conspiracy'. The fear of unrestrained crowds, mere puppets in the hands of suggestive conspirators is, for example, one of the most recurring topics in the texts of the Portuguese alienists (strongly influenced by the ideas of the pioneer of crowd psychology, Gustave Le Bon).4 Bombarda makes it explicit in his reflection on religious figures and their power over multitudes of the credulous. In a note about the Islamic religion and its epileptic, therefore degenerative, background, Bombarda writes inflammatorily:
True religions, which lead whole submissive races and men by the millions, find their original inspiration in epilepsy. Such is Mohammedism. Mohammed was epileptic.
When one contemplates certain epileptics carried to the peak of their religious delirium, one understands the pulling power that, on their own, they can exert on ignorant multitudes. (Bombarda, 1896a, p.325)
He refers, in the same context, to "madness epidemics" (Bombarda, 1896a, p.325), one of the most constant images of this loss of control over suggestible degenerate multitudes.
Júlio de Matos, in turn, would call attention to the enormous capacity for suggestion exerted by the crowd or group effect. One of the most obvious translations of this is in his invectives against a penitentiary system that, ignorant of the intoxicating qualities of pathological criminality, brings together in the same place "the criminally alienated" and the "ordinary alienated" (the degeneration arises here not only as a simple disease, but beforehand as an indelible constitutional trait):
In a large number of cases, the crimes of the alienated are not episodes of illness, but a sure indication of regressive degeneration that give them a special character and make them not only eminently dangerous, but deplorably disobedient. The entrance of this type of sick person into a normal infirmary is often signaled by a whole series of internal disturbances, as only one who knows the services of a insane asylum can appreciate. The spirit of lying and intrigue of this order of sick people, their tendency, so exceptional in others, to engage in conspiracies, their permanent insubordination, their vices, contracted in jails and houses of debauchery, their constant concern with escape, all make them components of disobedience and disorder. (Matos, 1903, p.22, 23)]
In light of this potential for suggestion and contagion, Matos will refine his microbiological and hygienic (preventive) conception of criminality. This modality of his thinking is patently found in his introductory exposition to the Garofolo treatise he translated, Criminologia, estudo sobre o delito e a repressão penal, published in Portuguese in 1893. Without going into detail, read, for example, the following quotation that reasonably attests to the microbiologist and hygienist notion of the criminality-degeneration continuum:
Just as microbes, miniscule beings of a rudimentary structure, insinuate themselves into the most advanced organisms and live in them parasitically, feeding on their elements, stealing their energy, producing diseases and often death, so do delinquents, inferior spirits break out in the most cultured societies, draining their strength, disrupting their activities, placing them in permanent fear.
Cholera, rabies, influenza, yellow fever, anthrax, tuberculosis and dozens of other afflictions betray the presence of the biological enemy; assassination, theft, arson, rape, calumny and dozens of other evils reveal the existence of the social enemy.
Medical statistics, showing us in every country the enormous number of those carried off by microbiotic legions to the cemeteries every day, only give us an approximate idea of the number attacked, because they do not count those that the disease left permanently weakened and irreparably deprived of the capital of existence, which cannot be measured; even less approximate is an idea of the victims that we can get from the criminal statistics of the various countries, since their numbers exclude all those whose moral or economic interests suffer because of each crime. Just consider that the murder of one man alone can make orphans of many children, that the burning of just one property can lead to the misery of dozens of people, that the calumny spread about an individual is reflected in countless social effects for his descendents and you will understand how obscure and irreducible to numbers is the devastating work of the delinquent. (Matos, 1893, p. i, ii)
Psychiatry in its forensic extension (in convergence with other knowledge) not only exercised the cultural work of producing ideas that later became disseminated in the social arena regarding these internal enemies of the system, but also how, on the strictly institutional plane, it came to develop decisive classificatory work in locating such enemies.
The degenerationist language was the current coin in the production of forensic studies on the criminally alienated, having very concrete implications for the life of specific subjects. To provide an example for present and future forensic specialists, Matos published Os alienados nos tribunais, a trilogy wholly consisting of forensic case studies that became jurisprudence in Portugal during the 20th century (Matos, 1902, 1903, 1907). Among the case studies published there, several resort to degenerationist language.
One of these cases concerns Manuel Carriço, a native of Sobreiro (Anadia), 29 years old (Matos, 1902, p.137-147). Carriço, an almost anonymous journeyman (were it not for his crime and especially for his entrance into the gallery of Matos' exemplary forensic cases), was accused of having gravely wounded with a sickle at six o'clock in the morning of April 12, 1901 an elderly neighbor, one who had helped him on several occasions (p.144). Carriço was interrogated on June 1 in court in Anadia, declaring then that he "attacked Peralta, because it felt right" (p.138; author's italics) . The apparent unintelligibility of Carriço's gesture, "led the judge to suspect that the defendant was alienated". After the first forensic examination conducted by two doctors of the district, who considered him 'alienated', the defendant was also subjected to a careful evaluation conducted by the Porto Medical-Legal Board, whose reporting magistrate was Júlio de Matos. Carriço had committed another crime in 1900 (also without apparent motive) that allegedly consisted of "beating an oxcart driver" (p.142). In the study dedicated to him, Matos writes at a certain point: "Carriço's crimes, in 1900 as well as 1901, are only episodes of his mental state and only reveal very characteristically the impulsiveness of inferior degenerates" (p.145; author's italics).
Another case, no less symptomatic, is that of a 51-year-old "farm hand", Ana Joaquina da Costa (Matos, 1902, p.209-223). A native of Figueiró (Amarante), Ana Joaquina was accused of having set fire to her house on June 20, 1901. The motive for the crime was not discovered. And, after having been released on August 7 of that year, "for lack of arraignment" (p.210), she did it again, setting fire to a neighbor's house on August 8. Given the uncertainty manifested by the options of the district, Ana Joaquina was committed to the Conde Ferreira insane asylum, where, within the competencies assigned to the Porto Medical-Legal Board, she was subjected to minute analysis by Matos. Not neglecting his recurring anthropometrical concerns, Matos said he was faced with "a degenerate having evident physical stigmas" (p.216), concluding his medical-legal observation with several paragraphs (in response to queries of the court) in which one can read early on the following: "Ana Joaquina da Costa is a hereditary degenerate, intellectually poorly gifted, who has suffered for several years from vertiginous epilepsy and recently from delirious fits, which have replaced the somatic crises of the neurosis" (p.223).
We are here faced with jargon that strongly permeated the forensic discussions enjoined around the criminally alienated. But, in a more contextual (and revelatory) form of its discursively effective character in the production of alterity, into which the technical knowledge of forensic knowledge fits in, it is important to emphasize the generalized dimension of such jargon in Portugal (and Western Europe in general).
The degenerationist specter desolated Europe, and the legal medicine of the alienated, the then emerging Portuguese forensic psychiatry, was, like its European counterparts (especially the French and Italian), a workshop of culturally decisive representations for the production of difference. The liberal and republican matrix of the time could not have been more propitious for the acceptance of such mechanisms of the production of difference. And, in large measure, the legal medicine of the alienated metamorphosed itself into a legal medicine of the degenerates with very vast professional and political contours, knowledge and requirements.
The institutional corollary of all this occurred on May 11, 1911, when the first major law to assist the alienated was published. Its main author was Júlio de Matos and it was endorsed by outstanding figures of the First Republic, emphasizing here the names of Joaquim Teófilo Braga, António José de Almeida, Afonso Costa, José Relvas and Bernardino Machado. It is fascinating not only to verify the uneasiness regarding the imponderable of mental insanity that the law above reveals, but also, and given the professional and political pretensions of psychiatry and its forensic extensions, the way in which the statistical severity of the problem was weighed. It also shows up more specifically the way in which the language of mental alienation and criminality metamorphose into a language that supports itself on the emblematic degenerationist matrix (with a strongly hereditary accent) of the times. Read here in the beginning of the introduction to the law:
The latest count of the Portuguese population reveals the existence of 6,600 alienated. There are, however, abundant reasons to believe that this number is far from the truth. Statistical work done in 1883 by Professor António Maria de Sena and published in Os alienados em Portugal, despite confessedly incomplete, disclosed at the time 8,000 insane. Taking into account that life in Portugal has been unquestionably more difficult and painful in the past 28 years, it is not in the least unlikely that that number is low; on the contrary, one must suppose that the sick people verified in 1883, living in freedom and reproducing, at least in part, had given rise, thanks to the inflexible laws of morbid heredity, to a considerable number of new alienated individuals. On the other hand, alcoholism, which 28 years ago was a very rare intoxication among us, has since then become progressively accentuated.
Considerations of another order lead us to judge that number of 6,600 alienated people to be excessively small, since the count of those assisted in the insane asylums of Lisbon and Porto amounted to approximately 1,200. If it were true, Portugal, with close to 5.5 million people, could be considered a privileged country if it had no more than 1.02 alienated people per each 1,000 inhabitants, a figure below the lowest ratios known in the cultured world. The truth is that neither the impression of the Portuguese alienists who had traveled abroad nor special reasons of whatever nature allow us to believe that we enjoyed in terms of madness such an exceptional situation in Europe.
But, even if we suppose the figure of 6,600 alienated people in Portugal to be correct, we would still play, in terms of assistance, a deplorable and shameful role. In fact, considering only the 1,200 mentally ill kept in the Lisbon and Porto insane asylums, Portugal hospitalized less than one fifth of its alienated, abandoning the other forsaken four fifths to be the cause of senseless crimes, social fears and progressive degeneration of the race. This fact is without precedent in the history of modern civilization.
And, unfortunately, as the figure of 6,600 alienated people perhaps only represents three fourths of reality, the picture of our misery is even more somber. (Colecção Oficial de Legislação Portuguesa5, 1911, p.834; author's italics).
The legal medicine of degenerates thus had a determining effect on the options to choose regarding individuals and communities whose lifestyles and practices, having little in common with, first, the liberal and then the republican matrix, mirrored a threat to the system. Alcoholics, prostitutes and homosexuals, in one way or another, were all the object of degenerationist enunciations. The range of the theory was of such magnitude that, for example, João Franco, the liberal political polemicist, would come to be derided as a case of degeneration (Ramos, 2001, p.31) Fernando Pessoa justified his "drama in people" in light of his reading of the works of Max Nordau, one of the most outstanding theoreticians of degeneration (Simões, 1980, p.259-272).
The death throes of a language
This is not to say, however, that the degenerationist theories were rigorously consensual. On the European plane, we know that such theories were not only the subject of disagreement, but also of irony and sarcasm. At the time when, in 1907 in Portugal, João Franco was the subject of degenerationist exegesis, Joseph Conrad published The secret agent, in which degenerationist tropes abound. The books of Conrad, are, as Pick (1996, p.160-162) shows us, a case in point, because we can detect there the agonistic and imprecise nature of such tropes. Conrad's books allow us to watch cultural and social unrest in the making, which the language of degeneration translated, reflecting in them the debates and irony with which they were also received and appropriated.
The perception that one encounters with a language endowed with wonderful possibilities on the current forensic, social and political plane is not, therefore, an anachronistic or merely retrospective attribution. The possibility of our being in the presence of a vocabulary of trauma also seems to have been understood by the contemporaries of psychiatrists and forensic psychiatrists at the close of the 19th century. It even seems to have been understood by the psychiatrists themselves. The perception of the explicatory maximalism in the degenerationist schemes is a contemporary note of some of their most frank defenders.
In 1896, Miguel Bombarda, an outstanding agent of the republican Cosmopolis, had published as a separatum "a contribution to the medical study of anarchism and regicide" (Bombarda, 1896b, p.569). In this study, Bombarda protests against the incivility of certain modes of pathologizing criminality (which is a note of symptomatic singularity in an author marked by a strong degenerationist agenda). In particular, he tells us it is urgent "to repress the quickness with which one accuses of madness those deeds that distinguish themselves by an extraordinary trait ... from those that are usual or current in present societies" (p.569). Addressing the hasty associations between madness and anarchism and degeneration and anarchism, he adds:
It is easy to say that an anarchist attack is an act of mental alienation. But let us distance ourselves from defense of the current constitution of our societies, let us remember all that can be provoked by the desperate passion or propaganda induced energy of those whose voices are smothered by an infinite complexity of interests, and we can very well estimate whether or not any of the anarchist attacks could have been the result of implacable logic, of the powerful consideration of an absolutely sane spirit. In other words, there would never be social revolutions except those undertaken by madmen, and history is replete with deeds that demonstrate to us the opposite conclusion.
The problem is above all a practical problem. Should we detain anarchist criminals in asylums? I have no hesitation in replying negatively, even though we can always and unquestionably believe some of them to be degenerates. We can affirm that societies are not only the result of judicious spirits, but also that the involvement of degenerates and unbalanced individuals is always and everywhere present. But there is more: if we attempt an analysis of the data using the elements previously set forth, we arrive at the impossibility of knowing where the normal spirit ends and is replaced by degeneration. (Bombarda, 1896b, p.569)
And further on, concerning the relationship between madness and regicide and degeneration and regicide, he will write:
I would say the same about regicide. We still have not demonstrated that madness is always at the base of the act. It is true that we have constructed a regicide type based on madness; this creation is far from reality; we went in search of elements found among the regicides; one gave us the physical stigmas of degeneration, another, mental stigmas, a third presented analogies with criminals, etc., and the data of all these different sources were packaged together to form a single type, the regicide. There is a procedure in this that we can only regard as erroneous; by these means, we end up labeling as crazy not only all criminals, but whole groups, whoever they may be, from among the most prudent and conservative professions and classes (Bombarda, 1896b, p.569, 570).
While it can be said that Bombarda did not abandon his degenerationist psychiatric proselytism, he now demonstrates in this text awareness of its risks, war, more cynically (but perhaps more appropriately), an awareness that the nature of such reasoning could, ironically, compromise his republican, if not even revolutionary, pretensions.
Be that as it may, there are many empirical reasons to give credit to the hypothesis that degeneration served to leverage the forensic pretensions of Portuguese psychiatry in the period through a radicalization of its rhetoric, which had a large impact in the public arena.
Between the Constitutional Monarchy (1834-1910) and the First Republic (1910-1926), Portuguese psychiatry and its forensic extensions were seriously compromised by the civilizational inflections that, in various ways, were the letter of the law among the country's intellectual elite. And if, in this sense, there is a continuum between the political culture of the liberals and republicans, it is as if, at any given moment, the discontinuity between these two political universes had been pointed out by the republicans, using a perception of the monarchy's unfinished business. And they did it by making use of the insidious social threats that the monarchy's negligence had overlooked, and that, wrapped in degenerationist tropes, were now brought forth to validate professional, technical and institutional pretensions. The nadir of this (its institutional consecration) is modeled in the law of 1911, which I have already mentioned. The introduction to the law cannot be clearer regarding this urgent plane of social transformation that the doctors of the Republic proclaimed and that only monarchical indigence had compromised. It reads:
Feeling vividly this degrading situation [this paragraph is followed by the fragment of the 1911 law that I cited], prof. António Maria de Sena, the first director of the Conde de Ferreira insane asylum, was able to get a law approved in Parliament in 1889 authorizing the government to construct four new insane asylums and special infirmaries annexed to the penitentiaries. However, this law was never effectively carried out during the 22 years subsequent to its passage, even though the numerous and abundant revenues that it created for the new buildings were fully collected. Everything disappeared in the abyss of the extinct regime!
The monstrosity bequeathed to us by the monarchy must be rectified. (COLP, 1911, p.834)
What the Republic intensified and dramatized would be the forensic, social and political operationality of medical and psychiatric knowledge. Some of the most noted historians of the Republic have recognized the importance assumed by knowledge and the medical and, especially, psychiatric agents. The Republicans not only based their social philosophy on an anthropological theory that presumed the difference in light of the degenerationist model, setting its practices of social exclusion based on such a model (the case of the Jesuits is undoubtedly one of the most somber pages of that process6), but also transferred its will to transform humanity to the medical-psychiatric matrix, for which many of them were reputed mediators. Rui Ramos (1994, p.415) accurately wrote that, along with pedagogy, "only one other science was treated so kindly by the Republicans: psychiatry. Perhaps psychiatry did not need to be Republican, but in 1910, the most famous Portuguese psychiatrists felt the need to be active Republicans, beginning with the civil chief of the October 5 revolution, Miguel Bombarda, director of the Lisbon insane asylum and a great figure in Masonry".
It should be noted that the political arena was now replete with figures who made up part of the medical class. As Rui Ramos (1994, p.415) again writes, "there were two doctors in the provisional government itself and 44 doctors and a medical student were elected to the Constitutional Assembly". The differences between the Constitutional Monarchy and the First Republic could not be more evident: "it used to be said that if the monarchy was the Empire of bachelor degrees in law, the Republic represented the advent of the Empire of doctors" (p.415). It includes the fact that in 1912, there was talk of appointing Júlio de Matos, then dean of the University of Lisbon and a well-known scholar of the regime, to be Minister of Public Instruction. It also includes the fact that José de Matos Sobral Cid took over that ministry in 1914. Rui Ramos comments, not without irony: "the psychiatric leadership has guaranteed efficiency in the manufacturing of healthy and active Republicans" (p.416). The medical and psychiatric order thus assumed power.
The emergence and consolidation of Portuguese style biopolitics seemed to have found its course. And what about the degenerationist language that had so well served the maximalist pretensions of psychiatry in its forensic extensions? One could say that it had already found itself being dismantled (a process that, in spite of everything, was seen to be a very long one in the Portuguese case), and, in this sense, Sobral Cid appears unavoidable.
He is a transitional figure. In some ways, he continues to be a tributary of the degenerationist language. At the same time, he seems to reject it vehemently. Thus, for example, in 1913 Cid published in Movimento Médico, a "fortnightly magazine of medicine and surgery" headquartered in Coimbra, a study entitled "The frontiers of madness". In this work, which is an exegesis concerning a detailed forensic opinion about a case of "litigant paranoia", the author, at the start of his text, seeks, on the one hand, to distance himself from the common sense readings on madness - the "madman of legend", whose sufferings would be revealed "by the disorderliness of his acts, by his delirious activity and by disintegration of the personality" (Cid, 1913, p.65, 66) -, while, on the other hand, he equally tried to distance himself from the most cultured and vulgar concepts of madness among the enlightened bourgeoisie of his time, ones precisely based on the degenerationist model". On this point, Cid reflects on what, at the time, were called "superior degenerates", figures of literary or artistic genius that marked their existence by an extreme arrogance with regard to aesthetic conventions and rules and social norms":
the hyper-cultured and lettered public tends to form a concept of madness that, while much broader, has the defect of being infinitely more vague and elastic in compensation.
The vulgarization of the theory of degeneration and the Lombrosian doctrines regarding the relationships between genius, crime and madness; the Scandinavian theater and certain modern medical style novels position us in a perspective that sees the field of mental disturbances through an excessively wide-angle: they give us a special mentality, disposed to embellish with the caption of madness or color with the label of degeneration all those personages in real life in whom one succeeds in discerning the outline of a phobia or obsession, or that are marked by an evident eccentricity, or a singularity of conduct or anomaly of character.
With this trend, a vast literature of psychopathic inquiry flourished, ready to scrutinize the biography of great men in search of a retrospective diagnosis that would be the key to explaining the genius of their work. (Cid, 1913, p.66)
What we can determine from this quotation is, fundamentally, an uneasiness in the face of an explanatory model that, because of its latitudinal character (it seems to explain everything and therefore explains nothing), begins to no longer satisfy the alienists (we see how in 1896 Bombarda showed his discontent with the colossal relevance that degeneration had been assuming). Cid is an example of this discontent.
What is clearest in Cid, one of the most prominent proponents of psychoanalytic trends in Portugal, is the progressive, but never completely realized, departure from the degenerationist model. One could assert that his 1913 study proclaims a radical abandoning of degeneration as a comprehensive scheme of mental alienation. But even in the 1930s he published a set of medical-forensic case studies, admittedly modeled after the famous Os alienados nos tribunais of Júlio de Matos (Cid, s.d, p.XV)7, in which he appeals to the degenerationist tropes and hereditary scheme (the "morbid inheritances") to classify the various forms of madness of the criminals being analyzed. When writing about the case of a "bloodthirsty pseudo-sadist" (p.41-59), Cid, referring to the bestiality practices of the subject under observation, a soldier who had raped and assassinated a young nine-year old girl in Palmela in June 1929, tells us:
Frequent among the savages and even tolerated and consented in certain inferior societies, bestiality is, by its frankly regressive nature, the sexual perversion par excellence of degenerates having a rudimentary and primitive mentality, even in those cases - cattle drovers, stable boys, shepherds - in which the force of external circumstances can explain it to a certain extent.
Thus, its presence in the sexual history of the accused is another element to integrate into the homogeneous set of reactions and behaviors that so flagrantly characterize the primitivism of his biopsychic organization (Cid, 1913, p.48).
Cid is the hesitant clinician, recursively marked by two models that in his exegeses struggle to the finish: the degenerationist model that he had inherited from the founding fathers - Bombarda and Matos, who he had to qualify as "unrivaled predecessors" (Cid, 1930, p.235) - and the psychoanalytic model. It is important to highlight that the ambiguity that is generated in the confrontation between these two models is undoubtedly inscribed in his forensic writing published in the 1930s and that this ambiguity translates the gradual (and slow) reception that psychoanalysis had been assuring for itself within psychiatry. We cannot forget that Freud died in 1939 and that the influence of psychoanalysis had made itself felt since the 1890s, when his therapeutic methods began to receive the attention of elements outside of Freud's circle, spanning - in its work of affirmation and tearing down previous models (which included degenerationist biological psychiatry) - the first half of the 20th century and assuring its normative status in the 1960s (Shorter, 1997, p.154).
Be that as it may, in the hesitations in Cid we have discovered a pivotal fact of 20th-century psychiatry: the progressive abandonment of degenerationist language. However, we have also discovered, in a cursive appreciation of the context, the tragic political performance during the death throes of such language.
Co-opted by eugenicists and social hygienists, degeneration would become an integral part of the Nazi ideology in the 1930s (Shorter, 1997, p.99). It was during this decade that Cid had published most of his influential forensic studies, some of them gathered in Psicopatologia criminal, others, perhaps the most stimulating (because of the descriptive and hermeneutic detail they reveal), published individually in specialized magazines (Cid, 1930, 1935).
* This article results from a broader investigation into the exercise of Portuguese forensic psychiatry at the close of the 19th century. Important moments in this project can be read in Quintais (2002, 2005, 2006). The title "Torrent of Madmen" is a citation/homage to O alienista by Machado de Assis (2001).
1 All quotations in this article have been freely translated from the original Portuguese.
2 For more comprehensive reading on the questions identified here, see, for example, the texts of Barrows (1990), Gould (1981), and Nye (1984). For its racist implications, refer also to the analysis that Blanckaert (1992) did of the "ethnography of decadence".
3 "Madness, the subject of my study, has been up to now an island lost in the ocean of reason; I begin to think it is a continent" (Assis, 2001, p.20).
4 A kind of fascination and repulsion for the dark forces contained in the crowd seems to occur in Western Europe between the 19th and 20th centuries. A scenario that I believe to be trasnferable to the Portuguese case, for several reasons, which, in themselves, provide room for another project. See, to this end, the influential studies of Robert Nye (1975, 1984) and the no less influential ones of Susanna Barrows (1990).
5 Hereinafter known as COLP.
6 See, for example, Ramos (1994, p.404-409).
7 Still having no publication date, this set of studies certainly date from the 1930s. The last study in fact is dated October 1934 (Cid, s.d, p.220).
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Submitted in January
Approved in February 2008.
Submitted in January