Kaira M. Cabañas shows that at the center of this advocacy stood such significant proponents as psychiatrists Osório César and Nise da Silveira, who championed treatments that included painting and drawing studios; and the art critic Mário Pedrosa, who penned Gestaltist theses on aesthetic response. Cabañas examines the lasting influence of this unique era of Brazilian modernism, and how the afterlife of this “outsider art” continues to raise important questions. How do we respect the experiences of the mad as their work is viewed through the lens of global art? Why is this art reappearing now that definitions of global contemporary art are being contested?
Learning from Madness offers an invigorating series of case studies that track the parallels between psychiatric patients’ work in Western Europe and its reception by influential artists there, to an analogous but altogether distinct situation in Brazil.
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Picture yourself sitting at a desk in the museum of a psychiatric hospital and reviewing medical file 19168. The patient's name is Claudina D'Onofrio. She is registered as thirty-one years old, white, Brazilian, and single. She was interned on April 4, 1940, and examined by Dr. Mário Yahn six days later. The next page shows ten fingerprints as well as frontal and profile ID photographs that were taken on the chair that is outfitted with identification numbers and sited to your left in the same room. Page 3, rather than continue with the clinical conventions, is a drawn portrait. If you turn back to the previous page, you notice that the portrait and photograph share some features: the shoulder-length, wavy hair is parted on the left, the eyebrows gently slope, the nose is slightly asymmetrical. This self-portrait differs from the photograph not only in its medium and use but also by the extent to which the portrait individualizes the subject: she wears a necklace, and floral details adorn the shirt's collar (fig. 2). But rather than look out to a potential viewer, the sitter lifts her gaze somewhat askance. In the course of the following pages you read that D'Onofrio had "delirious ideas of a persecutory character" and was consequently diagnosed as paranoid schizophrenic. The physician's report also records her physiological state: it provides information on the patient's circulatory, respiratory, and digestive systems as well as reflexes. You can see that Yahn initially prescribed psychoanalysis as treatment, although on another page he proposes lobotomy (leucotomia cerebral), pending the family's authorization. Some pages later, Dr. Eugenio M. O. Netto prescribes electroshock therapy. The file documents a series of such treatments in April and May 1942, providing a chart with the dates, resistance, time, voltage, and results: nada, ótimo, nada, ótimo (nothing, great, nothing, great).
You consult another file, number 3461. The patient's name is Pedro dos Reis. He is twenty-eight, white, Brazilian, and single. He was interned on September 7, 1946. The next page shows fingerprints and a single frontal ID shot. After a brief family history, you read that Dr. Nilo T. da Silva diagnosed him as schizophrenic and prescribed convulsive therapy as treatment. A questionnaire offers details about his family history and present illness. Questions with regard to the latter include: Has been agitated? Has been depressed? Had visions? Heard voices that did not exist? Nestled between the questionnaire's pages are two drawings: one a landscape with two houses and another a ship at sea. Both are drawn on paper from the Diretoria de Assistência a Psicopatas (Board of Directors of Assistance to Psychopaths). Where D'Onofrio's drawing seemed to aim toward a naturalistic likeness so as to correspond with her image in (real) life, Reis's agitated line doubles and redoubles the contours of the various objects he depicts, and the circulating lines of the land and sea seem rendered as if to capture their force rather than their form.
These files are part of the extensive medical archive at the Hospital Psiquiátrico do Juquery (formerly the Hospital e Colônia de Juquery; hereafter, Juquery or the Juquery hospital) in the São Paulo suburb of Franco da Rocha, about one hour by regional train from the city center (fig. 3). I reviewed the files in the Museu Osório César, presently located in one of the hospital's former female pavilions, under the name Núcleo de Acervo, Memória e Cultura. The questionnaires, charts, and typed and handwritten doctor reports these files contain record the medical practices used to treat mental illness, from lobotomy and electroshock to less physically invasive treatments such as psychoanalysis. The files testify not only to the overlapping of distinct therapies and paradigms (from the talking cure to invasive psychosurgery); the patients' drawings found therein bear witness to the outbreak of an interest in patients' art at Juquery in the 1920s and spread through to the 1950s. D'Onofrio's and Reis's work also forms part of the collection at the Museu de Arte de São Paulo (MASP), and their works were on view as part of the exhibition Historias da loucura: Desenhos do Juquery (Histories of madness: Drawings from Juquery) in 2015.
The traces of these creative practices as they persist in the patients' medical files are not unlike other patient strategies to recuperate their singularity in the face of disciplinary subjugation: from decorating their uniforms with plants and flowers to drawing on the hospital's walls. But how this art was first put to work in relation to modern art in Brazil is what I chart in this chapter: from the works' association with futurism to its exhibition in one of São Paulo's first venues dedicated to modern art. To do so, I must introduce the pioneering work of Dr. Osório César, in whose museum this chapter's research began.
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In addition to being a trained physician, César was also a musician, a violinist, a writer who published both art and music criticism, a communist political activist, and a professor. He began work at the Juquery hospital in 1923 (as an intern in the laboratory for bromatology and chemical analysis) and officially began work as an anatomical pathologist in 1925. According to his own testimony, when he arrived at the hospital, many patients routinely painted and drew. Although no space was exclusively dedicated to these activities, the hospital did begin to collect the patients' production so as to assemble it in a museum. In the Brazilian context, César was the first to systematically study and publish analyses on the creative work of mental health patients. Even so, he also continued to write articles on anatomical pathology that served as key references at the time.
About one female patient diagnosed with premature dementia (simply named "O" in the clinical file so as to protect the patient's identity), he writes, "She spends her days in the pavilion courtyard to paint still lives and landscapes of the surrounding area. And watercolor was principally her preferred type of painting." Other patients would similarly work in the courtyard and the hospital's other spaces, and César at times provided paper, graphite, and colored pencils to those who "spontaneously" drew or etched on the hospital walls. Other patients created small clay figures. Consequently, he began a collection to study the psychic factors motivating their artistic production, publishing his first article on the subject in 1924. In "A arte primitiva nos alienados" (Primitive art in the alienated) César discusses the symbolic character of patients' work as well as its style, which he compares to a futurist aesthetic (estética futurista), a designation frequently used as a synonym for modernist in the Brazilian context. The study is the first evaluation of psychiatric patients' work to be published within the São Paulo medical milieu.
Even though a few patients drew, their artistic production was not yet seen as potentially therapeutic, nor did they have the sort of studio space often found with art therapy practices today. Rather, the dominant therapeutic approach at Juquery was ergotherapy: a prescribed routine of physical work and relaxation (sometimes referred to as labor therapy and today developed into occupational therapy). In the early 1900s, such a conception of physical work as therapy drove the hospital's organization as well as the construction of its first Colônia Agrícola Masculina, an agricultural asylumcolony (with eighty patients) sited on Juquery's extensive and bucolic grounds, which measured nearly four hundred acres (see fig. 3). Within this regime patients were put to work and distributed according to labor type: some lived on a farm near the cultivated area, and some milked cows; others held maintenance jobs, working as gardeners, painters, or masons; some made shoes (fig. 4). Dr. Franco da Rocha, the hospital's founder and first director, explains how, "for them [the patients], the appearance of liberty, associated with moderate and profitable work ... is the blessing of civilization." Yet he acknowledges how such liberty was relative, and by 1908 the hospital had implemented a more progressive family assistance program.
In his 1912 report on the hospital and its history, Rocha also lists the fruits of the patients' labor: twenty thousand liters of corn, seven thousand liters of beans, a large quantity of fruits (e.g., oranges, grapes, apples, bananas, pineapple), and vegetables. But rather than focus exclusively on the quantitative yield that supports the hospital's functioning, which he affirms costs nothing to the state, he frames the payoff in moral terms: "The insane who works and sees the result of his sweat, feels more dignified; leaves the lowly condition of useless creature and is elevated before his own eyes; he adapts to a modus vivendi that greatly softens the disgrace. The consciousness of personal self worth revives in the individual, who, in another way, would be a heavy and useless charge for the healthy part of society." In this way, the dominant therapeutic approach at Juquery was an extension of the moral treatment first codified by Philippe Pinel, the founder of French psychiatry and the one whose removal of the inmates' chains is immortalized in the paintings Pinel fait enlever les fers aux aliénés de Bicêtre (Pinel orders the chains removed from the mad at Bicêtre, 1849) by Charles Müller and Pinel à la Salpêtrière (1876–1878) by Tony Robert-Fleury. Pinel recommended that the physician "console the patient by adopting a benevolent tone, ... prescribe a balanced diet, long walks, and above all sustained work in the field every day." Within this paradigm, physical labor helped to distract the patient from exclusive focus on his or her delusion and also allowed the physician to classify illness through observation and transcription. Patients at Juquery were, however, obliged to submit to regulation, obey orders, and conform to the regularity of certain actions and habits. This system of order is, as Michel Foucault maintains, "reality in the form of discipline." Pinel's act of "liberation" inaugurated a new articulation of psychiatric power.
In the 1920s, when César arrived at Juquery, the hospital had expanded significantly to include new pavilions, including one for abnormal children, and the first histochemical laboratory for studying cerebral pathology, thus ushering in an anatomical-pathological phase in Juquery's directorship and its medical practices. By 1928, it accommodated approximately two thousand patients within its various facilities, from the main hospital to the colonies. Faced with such an increase in number of patients (in 1907 there were 900; in 1912 there were 1,250), the core clinical team of seven doctors — four psychiatrists, two medical interns, and a surgeon for general medicine — was insufficient. With such a reduced team, and given the institution's geographic expanse, the guards and nurses constituted the hospital's real "motor." As Maria Clementina Pereira Cunha shows, Juquery's regime of order and discipline depended on the hospital workers' surveillance network, which served symbolically and, at times, literally as the doctor's eyes. Her excellent and harrowing study also demonstrates how the reality of Juquery was at odds with the idyllic image the psychiatrists promoted.
The patients' artistic production was a minor practice within the hospital. Early aesthetic studies, like that of Marcel Réja, emphasized how the work was produced out of "necessity," thereby informing modernist theories that would also uphold a psychological creative necessity as central to patient and nonpatient artists alike. As suggested in the introduction, this discourse is at odds with the development of notions of medium specificity. But such creative work also forms part of a genealogy in which patients have dressed up, subverted their uniforms, and asserted their singularity against the standardization imposed on them. In Foucauldian terms, I understand it as instances of counterpower, and thus as responses to the microphysics of power related to the history of the psychiatric institution. These creative practices opened a space — one close to what Gilles Deleuze and Félix Guattari theorize as a line of flight, evoking the act of fleeing and eluding, and the infinitesimal possibility of escape — that exceeded the hospital's disciplinary order. Yet as soon as patients' art emerged as an object of study, the patients' creative production passed a threshold and was inscribed within a new epistemic order: the various psychological studies that claimed to account for the meaning of this art and its relation to aesthetic modernism. At times this relation was positively framed. At other times it was forged in the service of conservative critique. Remember how in the Brazilian context Monteiro Lobato polemicized against Anita Malfatti's work and compared modern art with the "abnormal."
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In 1929, when Juquery counted more than two thousand patients, César published his seminal A expressão artística nos alienados: Contribuição para o estudo dos símbolos na arte (The artistic expression of the alienated: Contribution to the study of symbols in art, 1929; fig. 5), which includes eighty-four illustrations and a preface by Cândido Motta Filho. As in his earlier 1924 article, he offers a psychoanalytic interpretation of the drawings, paintings, sculpture, and poetry of patients at Juquery. At the time, scant literature was available in Brazil concerning the relation between art and madness — only Ulysses Pernambucano had studied the subject in the Brazilian context. In the introduction to his volume, César recognizes this challenge: "At first we encountered a huge number of difficulties: scarce literature among us, the lack of an artistic museum in the hospital, and mainly a lack of solid knowledge of the subject that we were going to study." Yet César's A expressão artística nos alienados reveals his familiarity with the historical work of Cesare Lombroso and Enrico Morselli and with the contemporary work of Walter Morgenthaler and Hans Prinzhorn, as well as Jean Vinchon. His volume even includes two reproductions of work from Prinzhorn's collection (figures 32 and 60 in César's book). He was thus aware of an emerging field in which the creative work of psychiatric patients had become the object of scientific and aesthetic scrutiny: Morgenthaler had published Ein Geisteskranker als Künstler (Madness and Art: The Life and Works of Adolf Wölfli) on the work of Adolf Wölfli in 1921; Prinzhorn's Bildnerei der Geisteskranken (Artistry of the Mentally Ill) had appeared in 1922; and Vinchon's L'art et la folie (Art and madness) was available in 1924. César's own book-length study, published not long after these three works, marks him as a pioneer in the field, both in the Brazilian psychiatric context and internationally.
Rocha, Juquery's founder, had this to say about César's publication:
His study comes to mark, for us, the beginning of a new direction in the examination and interpretation of delusions that are observed in the insane. ... Until now, everyone saw in the insane only complete mental disorder, incomprehensible absurdities, nonsense and no cohesive motivation for the behavior of the patient. ... The unconscious, which contains a world of tendencies, aspirations, ideas and complexes unknown to the patient himself, is what will provide the explanation of many things that until now were simply incomprehensible nonsense. The poetry, sculpture, painting, and art in general, in the manifestations of madness, bring an important contingent to the psychiatry of generations that now begin to study this subject.
At the time of César's book's publication Sigmund Freud's theories were already circulating in the medical and cultural contexts of São Paulo. In 1920 Rocha had published O pansexualismo e a doutrina de Freud (Pansexualism and Freud's doctrine; later republished as A doutrina de Freud in 1930). São Paulo was also the site of the first psychoanalytic society in Latin America. The Sociedade Brasileira de Psicanálise was founded on November 24, 1927, under the direction of Rocha and Dr. Durval Marcondes. Rocha served as its first president. The society's membership included doctors and intellectuals, among them César, A. de Almeida Júnior, and Motta Filho. Given Freud's robust reception in the local medical milieu, César decided to send some of his research to the Viennese doctor, who responded with a letter:
My esteemed colleague,
I am very grateful for the delivery of your work in "Memories of Juquery Hospital," which at least in the French translation was accessible to me.
If you want to send us a German translation of your new work, I can already guarantee its inclusion in our "Imago" magazine, where it will readily find reception.
I am very pleased to have this proof of the interest that our psychoanalysis has aroused in Brazil.
Excerpted from "Learning from Madness"
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Table of ContentsIntroduction: Toward Discomfort
1 Clinical-Artistic Tableaux
2 Common Creativities
3 Physiognomic Gestalt
4 Bispo’s Contemporaneity
5 Monolingualism of the Global
Notes on the Text