Home Institution

Yale University

Publication Date

Spring 2010

Program Name

Brazil: Social Justice and Sustainable Development


In 1987, as public health decentralized and O Movimento da Luta Antimanicomial challenged the internment of loucuras in asylums, Brazil hosted its first National Conference of Mental Health. While the fight for mental health reform and the dehospitalization of the mentally ill in psychiatric hospitals began to take form in the 1970s with the Rede de Alternativas Psi and O Movimento dos Trabalhadores de Saúde Mental, Brazil has battled with questions of saúde loucura (treatment of the mad) since the country's colonial era and the reception of the epileptic and mentally ill family of Dom João VI. The Brazilian state of Ceará's mental healthcare history begins closer to the attainment of Brazilian independence, with the creation of the Asilo de Alienados in Parangaba, Fortaleza in 1886. The asylum aimed to take the insane and indigent from cramped city centers and far-off interiors and place them in controlled detention centers, attending to patients with the often cruel therapies and psychiatric treatments of the day. Throughout the 20th century, with no access to mental healthcare in interior municipalities, those deemed psychotic were transported, generally involuntarily, to psychiatric hospitals in Fortaleza for indefinite internments, away from family members and with no seen benefit for the patients. With the rise of a democratic Brazil, came the beginnings of political responsiveness to outcries for human rights for those with “deficiencies” and accessible healthcare in the country's vast interior regions. The push for a reassessment of mental health treatment came directly from the militant groups of students and healthcare professionals behind NAPS/CAPS (The Nucleus for Psychosocial Attention and the Center for Psychosocial Attention), which began as municipalityfunded projects for local mental healthcare. My research focuses on the work of Ceará's third CAPS, founded in 1993 in the municipality of Quixadá. This thesis asks if political policy instituted following the decentralization of public healthcare in Ceará succeeds in dealing with the necessities of the long-mistreated and ignored populations suffering from mental illnesses in the state's interior. The introduction of this work 4 displays a brief history of Quixadá and the treatment of those deemed loucuras from the late 18th century up until the movements for antimanicomial reform (anti-institutionalization of the insane) and human rights in the late 20th century in Ceará, with a focus on the sertão (the state's semi-arid interior). I then examine the creation and physical and theoretical development of CAPS in Quixadá and its efforts to change the culture of mental health treatment both through clinical treatment and political activism during the 1990s up until the current day. In this examination, I highlight the uniqueness of the municipality's organization and the connections between its mental healthcare and local realities. In the following chapters, I argue that the CAPS – Quixadá approach – under the initial leadership of Raimundo Severo, coordinator Dr. Carlos Magno Cordeiro Barroso, supervisor Dr. José Jackson Coelho Sampaio, Secretary of Health and Social Assistance, Dr. Ivonete Dutra and a team of multi-professional militants from various reform movements in Brazil – illustrates the potential of mental healthcare reform in Brazil, while highlighting the shortcomings of the SUS (System for Unified Healthcare) and the Ministério da Saúde (Ministry of Health). I emphasize the capability of the CAPS – Quixadá team to force the citizens of its city to rethink prejudices against the mentally ill in conventional methods of treatment through the reintroduction of the loucura into regular, community life, demonstrating the strength of family consultations and art-based therapies. In conclusion, I argue the need for a nationally-implemented mapeamento (detailed survey) of mental health conditions in all Brazilian municipalities, a reassessment of the preconditions for the creation of a CAPS facility, additional federal resources for CAPS and a questioning of the inefficiencies of government legislation meant to improve the rights of those in need of mental healthcare from 1989 until the present day.


Mental and Social Health | Public Health


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