Historical sketches of the beginnings of the academic "Mental and Nervous Diseases" in Brazil, and European influences

Esboços históricos do começo acadêmico das "Doenças mentais e nervosas" no Brasil e influências européias

Abstracts

We present the common milestones of the neurology and psychiatry in Brazil, but, previously, they were summarized in the European matrix. The main psychiatric and neurological historical interceptions may be recognized by the terms neurology, psychiatry, alienism, neurosis and insanity; its organogenesis or socio- and psychogenetic basis; and its proximity or distance from internal medicine.

neurology; psychiatry; neuropsychiatry; history; neurosciences

Apresentam-se as etapas comuns da neurologia e da psiquiatria no Brasil, porém, essas etapas foram previamente resumidas na matriz europeia. As principais interceptações históricas psiquiátricas e neurológicas podem ser reconhecidas pelos termos neurologia, psiquiatria, alienismo, neurose e insanidade, sua organogênese ou base social e psicogenética e a sua proximidade ou distância da medicina interna.

neurologia; psiquiatria; neuropsiquiatria; história; neurociências

The organic basis of psychiatry, or on the opposite direction, the socio- and psychogenetic basis, gives the historical forward or backward tropism to neurology. In this article, we comment on this journey in Brazil, but first we make a summary of the main confluent or differential historical hallmarks of neurology and psychiatry that led their way in Europe.

THE NEUROLOGICAL AND PSYCHIATRIC BOUNDARY

The construction of the modern neurology and psychiatry stems from the seventeenth century. The critical points of the parallel history of neurology and psychiatry are shown in Fig 1. In short, the field and development of both specialties came from internal medicine. Much of this initial development was studied by Bogousslavsky and Moulin¹ in a paper that presents the historical backbone of the French neurology and psychiatry.

Fig 1
European milestones, mainly French and German, of the common history of psychiatry and neurology1-4,6.

The emergence of neurology as an autonomous and prestigious field occurred in the late nineteenth century in Paris lead by Jean-Martin Charcot (1825-1893). A chair of Clinical Diseases of the Nervous System (1882) was established at the School of Medicine in Paris and occupied by Charcot. Previously (1875), a chair for Clinic of Mental Illness and Diseases of the Brain was devised, in the same School of Medicine, under Charcot's influence¹. However, the unity of Charcot's School took place around the study of hysteria, as hysterical women with somatic manifestations were commonly admitted to La Salpêtrière. Indeed, the alienists had always claimed their disinterest for this condition at the time. The alienists were trying to explain all cases of insanities as a result of brain lesions, but they mainly focused on patient management. However, considering research and scientific teaching, the accomplishment was poor. Conversely, the influent School lead by Wilhelm Griesinger (1817-1868) carried out research based on anatomoclinical method²-⁵. Moreover, another group guided by Benedict-Augustin Morel (1809-1873) combined anatomoclinical (not obvious anatomical lesion) and philosophical methods to propose a degenerative theory for mental disorders¹,³.

The proximity of neurologists and modern psychiatrists led to the emergence of "neuropsychiatrists" from the nineteenth century until at least two-thirds of the twentieth century¹. At the beginning of the twentieth century, Sigmund Freud (1856-1939) promoted the theory of psychoanalysis and helped to define the modern concept of neurosis². By this time, most psychiatrists already believed that the insanities were of organic etiology, while the neuroses were of psychological origin - exactly the opposite of what was believed at the beginning of the nineteenth century³. However, some psychiatrists and neurologists still believed that the neuroses were caused by organic changes²,³. Regarding the psychiatric field, Freud and Emil Kraepelin (1856-1926) became the two most influential personalities in the early twentieth century⁶, and neuropsychiatry was an emerging discipline attracting the interest of many students of brain pathology, particularly in the German-speaking world⁶. After World War II, the division between neurology and psychiatry became explicit⁶.

THE BOUNDARIES BETWEEN NEUROLOGY AND PSYCHIATRY IN BRAZIL

Tracing back, the history of Brazilian neurology and psychiatry goes to 1831⁷. The milestones of this path are given in Box, unfolded in articles published by at least one of the author of the present paper⁵,⁷-⁹. Early in the twentieth century, neurological and psychiatric institutions were formed around Hospices, and in Rio de Janeiro, Brazil, around the National Hospice for the Insane. This stream gave a heritage to the most influential Forerunner School of Psychiatry and Neurology in Brazil. The map of the area (Fig 2), presently the Campus of Praia Vermelha of the Federal University of Rio de Janeiro (UFRJ), demonstrates how close they were. The Brazilian neurology emerged mainly from internal medicine during the second half of the nineteenth century. However, on academic grounds as a chair, it was linked to psychiatry. Antonio Austregesilo Rodrigues de Lima, the first to hold a chair of neurology in Brazil, was strongly attached to the Brazilian psychiatric school⁸, in opposition to Charcot who had absolutely no connection with mental alienation ("psychiatry") tradition and school¹. Despite their different profile, the "neurological-looking" clinical manifestations of the hysterical patients impressed Charcot¹ and, in the same way, Austregesilo.

Chart.
Timeline of the Brazilian neurology and psychiatry beginnings5,7-10.

• The original names in Portuguese (except personal names) were translated to English for a broader understanding.

Fig 2
The main structures of the old Hospice (National Hospice for the Insane), and its secondary buildings are visualized.

CONCLUSION

In Brazil, the cathedra of neurology came from academic psychiatry rather than internal medicine, in spite of the great influence of this last one on clinical practice and academic forum. However, the hospice central importance for mental health care and also for neurology faded in Brazil and worldwide. One major reason was the development of psychotropic drugs (neuroleptics and antidepressants), and penicillin, for the treatment of neurosyphilis, which favored a move of the major psychotics to outpatient care¹⁰. Despite this dispersion, the area surrounding the ancient National Hospice for the Insane became an important center of the activities of Brazilian neurology and psychiatry.

References

• ¹
  Bogousslavsky J, Moulin T. From alienism to the birth of modern psychiatry: a neurological story? Eur Neurol 2009;62:257-263.
• ²
  Køppe S. Neurosis: aspects of its conceptual development in the nineteenth century. Hist Psychiatry 2009;20:27-46.
• ³
  Beer MD. The dichotomies: psychosis/neurosis and functional/organic: a historical perspective. Hist Psychiatry 1996;7:231-255.
• ⁴
  Shterenshis MV. The position of nervous diseases between internal medicine and Psychiatry in the XIXth century. Vesalius 1999;5:67-71.
• ⁵
  Gomes MM, Engelhardt E. Meynert and the biological German Psychiatry. Arq Neuropsiquiatr 2012;70:894-896.
• ⁶
  Martin JB. The integration of neurology, psychiatry, and neuroscience in the 21st century. Am J Psychiatry 2002;159:695-704.
• ⁷
  Gomes MM, Engelhardt E, Chimelli LC. The first Brazilian Neuropsychiatrist, José Martins da Cruz Jobim, tuberculous meningitis and mental disease. Arq Neuropsiquiatr 2013;71:191-193.
• ⁸
  Gomes MM, Cavalcanti MT. National hospice for the insane and the Brazilian Neurology in the beginning of the 20th century. Arq Neuropsiquiatr 2012;70:823-825.
• ⁹
  Gomes MM, Cavalcanti JL. The Brazilian Neurology centenary (1912-2012) and the common origin of the fields of neurology and psychiatry. Arq Neuropsiquiatr 2013;71:63-65.
• ¹⁰
  Lucena J. Raízes e tendências da psiquiatria no Brasil. Rev Neurobiologia 1978;41(Suppl):S5-S48.

Publication Dates

• Publication in this collection
  Aug 2013

History

• Received
  31 Jan 2013
• Reviewed
  18 Apr 2013
• Accepted
  25 Apr 2013