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This article offers a historical overview of the way by which the state of Espírito Santo dealt with the matter of madness as a social problem from the end of the nineteenth century until the 1950s. By targeting the development of medical knowledge and its institutions in the local sphere, we will try to understand the main characteristics assumed by the treatment of mental illness - and the place occupied by crazy individuals - in Espírito Santo's society during the referred period. By basing our analysis on Foucault's critics of the so-called exclusion games brought about by scientific kwowledge in modern times, it will be sustained that the institutionalization of the medical treatment of mental illness in Espírito Santo did not serve to overcome its old repressive and police practices but to intensify a process of exclusion of insane individuals which took place in that society at least since the last part of the nineteenth century. In order to prove that hypothesis, we will analyse entry books, medical records and interviews granted by some employees of Audauto Botelho Hospital: the main institution responsible of turning the treatment of madness in Espírito Santo into a modern medical enterprise during the 1950s.

Resumo O artigo analisa a obra “O alienista”, de Machado de Assis, a partir de um diálogo com a historiografia (nem sempre escrita por historiadores) que, desde o final dos anos 1970 até períodos mais recentes, investiga tanto as práticas de intervenção psiquiátricas vigentes no Brasil da segunda metade do século XIX até o começo do XX quanto os aportes teóricos e as lógicas de poder e sociabilidades que davam sustentação a tais práticas. A perspectiva aqui assumida interpreta “O alienista” como um vigoroso “testemunho histórico”, num registro eminentemente crítico, dos momentos iniciais de implantação da medicina mental no Brasil e de seu correlato institucional, que é o hospício. Abstract From the early 1970s until more recently, historiography (which is not always written by historians) has investigated the psychiatric intervention practices that prevailed in Brazil from the latter half of the nineteenth century through the early twentieth, along with their theoretical foundations and the underlying logics of power and sociability. The article analyzes the novella “The Alienist,” by Machado de Assis, by engaging in dialogue with this field. The book is interpreted as a robust and eminently critical “historical witness” of the early emergence of mental health medicine in Brazil and its institutional correlate, the asylum.

Discutem-se aqui as formas de encaminhamento de pacientes ao Hospital Adauto Botelho, localizado em Cariacica, Espírito Santo. A pesquisa se deu por meio de prontuários médicos datados desde a inauguração em 1954 e de depoimentos de pessoas que trabalharam lá durante a segunda metade do século XX. Foram analisados 102 prontuários e entrevistadas quatro pessoas. A pesquisa dos prontuários mostra forte inserção da Chefatura de Polícia no processo de internação. As falas dos entrevistados reiteram esse ponto, mostrando também a longa duração das internações. São as histórias de vida dos internos que dão o tom deste trabalho. Conclui-se, a partir delas, que o Hospital Adauto Botelho, mais que uma instituição de tratamento, era um espaço de confinamento. This paper discusses the procedures for referring patients to Adauto Botelho Hospital, in Cariacica, Espírito Santo state, Brazil. The research is based on the medical records since its inauguration in 1954 and statements by people who worked there in the second half of the twentieth century. One hundred and two records were analyzed and four people were interviewed. The records revealed the active involvement of the Chief of Police in hospitalizations. The interviews corroborate this, while also showing the long duration of the hospitalizations. The tone of the paper is set by the life stories of the people hospitalized there. The conclusion is that this hospital served not so much for treatment as for confinement.

Analisa duas concepções antagônicas sobre a constituição do campo psiquiátrico. A perspectiva prevalente no Brasil, a foucaultiana, é contrastada com a perspectiva de Gauchet e Swain. Para a tarefa são abordadas duas obras de Foucault, A história da loucura e O poder psiquiátrico, e a obra de Gauchet e Swain, Madness and democracy. Propõe que as concepções de base sobre o que é e como se construiu o campo teórico psiquiátrico definem as estratégias políticas e assistenciais de uma sociedade na sua relação com a loucura. Aponta as consequências diversas que essas abordagens trazem para a reforma psiquiátrica brasileira. The article analyzes two opposing views of the formation of the psychiatric field: the Foucauldian perspective, which holds sway in Brazil, and the perspective of Gauchet and Swain. Two works by Foucault (History of Madness and Psychiatric Power) are contrasted with Madness and Democracy, by the latter authors. It is argued that a society's political and assistance strategies about madness are shaped by the conceptual bases defining what constitutes the field of psychiatric theory and how it was formed. The article calls attention to the diverse consequences that these two approaches may have on the reform of Brazilian psychiatry.

Este artigo analisa, em especial, um dos instrumentos de anamnese produzido e aplicado pelos médicos do Asilo de São João de Deus, em Salvador (Bahia), a partir de 1874, ano da sua instalação. A pesquisa localizou, no Arquivo do Estado da Bahia e no da Santa Casa da Misericórdia da cidade do Salvador, acervo documental importante para a compreensão não só da história asilar, mas da história da psiquiatria na Bahia. Entre esses documentos foram encontrados cerca de vinte questionários preenchidos pelos médicos baianos daqueles dias. O nosso interesse nesses questionários, desenvolvidos pelos alienistas baianos, é analisar o conhecimento médico sobre a loucura e o seu tratamento, como também identificar as maneiras engendradas na condução do cotidiano asilar, numa tentativa hermenêutica de privilegiar o simbólico do passado tendo em vista o presente. The article relies on a collection of documents located at the Bahia State Archives and the city of Salvador's Santa Casa da Misericórdia Archives to gain an understanding of the history of asylums and of psychiatry in Bahia. The analysis is centered on one of the tools applied in taking anamneses, designed and employed by Bahian alienists at the São João de Deus Asylum in Salvador, Bahia, starting when the institute opened its doors in 1874. In a hermeneutic effort to view the symbolism of the past in light of the present, the article uses twenty of these questionnaires as a way of analyzing medical knowledge of madness and its treatment and further of identifying the methods devised for guiding daily life in an asylum.