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MENTAL HEALTH

Atelier Juquery

Sculptures and paintings reflect the work of physician Osório Cesar, who championed the role of art in psychiatric hospitals

An exhibit of work by unidentified artists mirrors the emotions of patients at a psychiatric hospital

Osório Cesar Museum/Juquery Archive/Reproduction by Eduardo Cesar An exhibit of work by unidentified artists mirrors the emotions of patients at a psychiatric hospitalOsório Cesar Museum/Juquery Archive/Reproduction by Eduardo Cesar

Brightly colored portraits show men and women with big eyes and leering stares. In one, a knife cuts through a head; in another, the intense red splatters like blood on the canvas. Few of the almost 100 works brought together in an exhibit at the Emílio Ribas Museum of Public Health, associated with the Butantan Institute, are signed. All of the artists, however, were patients with mental illness at the Juquery Psychiatric Hospital, one of the largest of its kind in Brazil. Known today as the Juquery Hospital Complex, it reached maximum occupancy in the 1970s, when it held almost 15,000 patients, including people detained for political reasons.

Implicitly, the art brings to the fore questions without clear answers – what is art? Who is or can be considered an artist?  Explicitly, the works reflect the innovative approach of the physician, Paraiban art critic and musician Osório Thaumaturgo Cesar (1895-1979). Beginning in the 1920s, as head of the art department and subsequently founder and director of the Juquery Free School of Fine Arts, he emphasized the value of art created by people with mental illness, alongside the work of Alagoan psychiatrist Nise da Silveira (1905-1999), two decades later at the National Psychiatric Center in Rio de Janeiro.

Both physicians spent a lot of time with artists, writers and other intellectuals, were communists – they were arrested several times – and defended artistic free expression as a means to restore emotional stability in people with mental illness, based on studies of the unconscious by Austrian neurologist Sigmund Freud (1856-1939), the father of psychoanalysis, and Swiss psychiatrist Carl Gustav Jung (1875-1961), the founder of analytical psychology. The use of art in this way arose in Europe, the United States and other countries like Brazil, as a possible alternative to the violent treatment methods used in the early 20th century, like lobotomy, electroshock therapy and inducing fever to mitigate the effects of mental breakdowns. Medications to treat mental illness were first used in the 1950s.

Sculpture by Maria Aparecida Dias

Osório Cesar Museum/Juquery Archive/Reproduction by Eduardo Cesar Sculpture by Maria Aparecida DiasOsório Cesar Museum/Juquery Archive/Reproduction by Eduardo Cesar

Although similarly motivated, Cesar and Silveira used different approaches, according to occupational therapist Elizabeth Araújo Lima, professor at the Faculty of Medicine at the University of São Paulo (FM-USP) and author of the book Arte, clínica e loucura: Território em mutação [Art, clinical practice and madness: a changing field] (Summus Editorial/FAPESP, 2009), the result of her doctorate in clinical psychology at the Pontifical Catholic University (PUC) in São Paulo. A follower of Freudian analysis, Cesar led the Free School of Fine Arts with the main goal of giving patients skills they could use professionally after leaving the hospital. Nise adopted Jung’s analytical psychology and did not go along with the traumatic treatment methods of the time. In 1946, when she became director of the occupational therapy department at the Rio de Janeiro hospital, she began to develop her own treatment method, drawing on the paintings and sculptures produced by patients to encourage mental reorganization.

Lima says that Nise’s work became more well known than that of Cesar for several reasons. Portrayed in several films – the most recent is Nise, o coração da loucura [Nise, the heart of madness] from 2015 and directed by Roberto Berliner – the psychiatrist established an institution in 1952 that is still functioning today, the Museu de Imagens do Inconsciente [Museum of Images of the Unconscious] in Rio de Janeiro, where she carefully stored the works of her patients to document the possible improvement in their mental states.

Cesar, in turn, sold some of the artwork produced by his patients to support his school and remained at the hospital until 1965, when he retired for political reasons. The school was closed in the 1970s. The artwork was dispersed until art historian Maria Heloisa Corrêa de Toledo Ferraz, currently a retired professor of the USP School of Communications and Arts, collected it in the 1980s, with the assistance of other researchers. Author of the book Arte e loucura: Limites do imprevisível [Art and madness: limits of the unexpected] (Lemos Editorial, 1998), Ferraz participated in the retrieval of 2,258 works and in establishing the Osório Cesar Museum, founded in 1985 in one of the hospital’s former pavilions.

Hard at work: the art room in the 1950s

Alice Brill/Moreira Salles Institute Archive Hard at work: the art room in the 1950sAlice Brill/Moreira Salles Institute Archive

“With the eye of an art critic,” says historian Josiane Oliveira, director of the Emílio Ribas Museum, “Cesar brought attention to the quality of the artwork produced by people with mental illness, even promoting exhibits of the art produced at Juquery in public spaces and art museums.” The first exhibit was in 1933, including the Mês dos loucos e das crianças [Month of the crazies and children], organized by the artist Flávio de Carvalho (1899-1973) at the Modern Artists Club. The São Paulo Museum of Art (MASP) organized three exhibits of artwork from Juquery, the first in 1948 followed by one in 1954 and, from the archive donated by Cesar, the most recent in 2015.

Cesar grew up in a musical household in João Pessoa, capital of Paraíba state. Grandson of a maestro who led musical groups that encouraged residents to listen to opera, nephew of a violinist and composer of waltzes, son of a choir director and professor of musical theory, he earned money as a violinist and violin teacher to support himself while studying dentistry in São Paulo from 1912 to 1916. After that, he attended medical school in Rio de Janeiro and in 1925 began work at Juquery as a medical assistant in the anatomy-pathology lab.

Violinist and anatomist
Cesar was one of the doctors responsible for autopsies, which he used in an effort to associate possible changes in the brain with mental illness. There were about 200 brains and other anatomical remains of patients from the 1920s and 1930s stored in jars filled with formaldehyde on wooden shelves in six rooms in one of Juquery’s buildings; at the entrance to one of them sits the undated brain of a 35-year-old patient with microcephaly. Another room holds material that has hardly been touched: autopsy registries from 1921 to 1979 and dozens of boxes piled high and containing around 5,000 glass negatives.

Professional identity card for Osório Cesar in 1937

Osório Cesar Museum/ Juquery Archive/ Reproduction by Eduardo Cesar Professional identity card for Osório Cesar in 1937Osório Cesar Museum/ Juquery Archive/ Reproduction by Eduardo Cesar

Shortly after he arrived at Juquery, Cesar observed that patients drew on the floor and walls or made sculptures with leftover breadcrumbs. “He was surprised by the similarities he saw with modern art, and he appreciated the patients’ work,” says Lima. She says the opposite occurred in Germany. The Nazis used the fact that art created by the so-called mentally ill was similar to modern art to denigrate it, calling it undesirable and harmful to the public. According to Lima, the Brazilian doctor believed that artistic expression of those labelled mentally ill “was essential to people trapped in a life behind hospital walls, providing them refuge in a world of beauty.”

In 1929, Cesar published his first book, A expressão artística nos alienados [Artistic expression in the mentally ill], in which he analyzed drawings, paintings, sculpture and poetry produced by the patients at Juquery through the lens of psychoanalysis. “An individual with mental illness does not deserve society’s contempt or neglect,” he wrote. “Within his world and its surroundings and the inner perspective of his “I,” the patient’s perspective is abnormal. But outside of that, he is as perfect or imperfect as any other human being.”

The book “became required reading not only for those working in psychiatry but also for Brazil’s intellectual elite,” says Ferraz in her book. Psychiatrists in São Paulo and Rio de Janeiro encouraged him to push forward with his research. Since 2015, when he began his review of patient records, João Fernando Marcolan, a professor of psychiatric nursing at the Federal University of São Paulo (Unifesp), found records of doctors who had sent patients to art class, a clear indication that the benefits of art therapy were recognized as early as the late 1920s.

Drawing of Freud done by one of the patients, Istvan Csibak

Osório Cesar Museum/ Juquery Archive/ Reproduction by Eduardo Cesar Drawing of Freud done by one of the patients, Istvan CsibakOsório Cesar Museum/ Juquery Archive/ Reproduction by Eduardo Cesar

Welcomed by intellectuals and artists, Cesar met writers like Mário de Andrade and artists like Di Cavalcanti and Tarsila do Amaral, with whom he lived and traveled to Europe. “Cesar promoted the art of modernists in Europe,” says Rodrigo Lopes de Barros Oliveira, a professor of Latin American literature at Boston University in the United States at a conference held at USP on September 1, 2016. In July 1931, Oliveira says Cesar sent a letter from Leningrad to Mário de Andrade, requesting that he send his books to Russian critic and translator David Vygodski (1893-1943), who was putting together a collection of South American literature and had not yet received a contribution from Brazil.

Challenging conventional notions of the era about what constituted art and who could be considered an artist, Cesar believed the patients institutionalized at Juquery who painted and sculpted were artists. But were they? “The fact that they were considered mentally ill and that they were institutionalized did not mean they couldn’t be artists nor did it guarantee that they were,” says Lima. “Cesar analyzed their work based on esthetic qualities, not the mental state of the individuals who created it.”

This was controversial. At a conference held at the close of an art exhibit held at the National Psychiatry Center organized by Silveira in Rio de Janeiro in 1947, Pernambucan art critic Mario Pedrosa (1901-1981) attributed the skepticism of even avant guard artists to “vestiges of intellectual bias” and a “rather anachronistic view of the issue.” According to Lima, the connection between Pedrosa and Silveira opened the door for the acceptance of artists who lived at psychiatric hospitals. One of the most well-known is Arthur Bispo do Rosário (1909-1989) from Sergipe State. One of his works is part of the exhibit, The keeper, on display until September 2016 at the New Museum of New York.

Juquery Central Hospital in the early 20th century

Osório Cesar Museum/Juquery Collection Juquery Central Hospital in the early 20th centuryOsório Cesar Museum/Juquery Collection

American psychologist Margareth Naumburg (1890-1983) and English artist Adrian Hill (1895-1977) provided the structure for the field of art therapy in the 1940s. Today in Brazil, artistic activities are used mainly to promote social integration and enrich the cultural lives of the mentally ill and the health professionals who serve them, according to a study conducted by a team at FM-USP published in January 2017 in the journal História, Ciências, Saúde – Manguinhos [History, Science, Health – Manguinhos].

Leading the survey, Occupational Therapist Ana Tereza Galvanese followed 126 activities of this type offered by 21 Psychosocial Care Centers (CAPs) in the city of São Paulo, and she confirmed that the so-called art and culture workshops cover not just art but also museum visits, dance, film, video, photography and dramatic play, inside and outside the care centers.

In an article in the journal Psychology and Psychotherapy from June 2016, researchers at the University of Sheffield, England, call attention to the benefits of art therapy as a mental health treatment strategy, underscoring the importance of the patient’s choice in the methods of treatment he wishes to use (medication or art therapy), and highlighting the need for professionals to tailor strategies appropriate to each patient.

Building housing the director’s office, still not renovated after a 2005 fire

Eduardo Cesar Building housing the director’s office, still not renovated after a 2005 fireEduardo Cesar

In transformation
Designed by architect Francisco Ramos de Azevedo and built in 1898 in what is now the municipality of Franco da Rocha, in the São Paulo metropolitan area, Juquery was a frightening place. Notwithstanding the efforts like those of Cesar to create safe spaces, there are many reports of naked patients abandoned on outdoor patios and others who died shortly after being institutionalized, usually because of dysentery, clear evidence of the neglect they suffered at the hands of the institution.

For the last year, Marcolan has been mining, with increasing surprise, the little-studied archive of 80,000 medical records for patients hospitalized since 1895, which are organized in a room in the front of the museum. The records have allowed him to establish how the institutionalization reflected the habits and values of Brazilian society at the turn of the 20th century.

“It was common practice to institutionalize women whose behavior was considered unacceptable, such as wanting to go to dances on their own, enjoy themselves, or having lost their virginity before marriage,” he said. “In the early 20th century, many of those institutionalized were black men, thought of as vagrants and degenerates because of the belief in eugenics and racial purity. The mere fact of being an unemployed black man justified institutionalization for vagrancy.” Marcolan found records of individuals who had been committed for political reasons during the government of Getúlio Vargas (1930-1945), but he has not yet found records during the era of Brazil’s military regimes (1964-1985).

The situation began to change in the 1980s, with a rewriting of the standards of psychiatric treatment, which emphasized deinstitutionalization and the intervention of physicians supported by Governor André Franco Montoro (1983-1987), who opened the institution’s most dilapidated cells and wings, from which, in previous eras, patients left only after death. Today, more than half of the grounds are occupied by the Juquery State Park, set up to preserve the native forests of the Cerrado. Municipal and state service agencies occupy nine of the 60 buildings, which are generally surrounded by trees and grass. A new building holds a trauma hospital completed in 2011, and a comprehensive mental health care center, with beds for up to 45-day stays, is operating in one of the old 1500-square-meter pavilions.

Six pavilions still hold 123 patients, most of whom have schizophrenia or developmental disabilities. Their median age is 60, and on average they have lived at Juquery for 35 years. Without family or appropriate outside placements, they are “relics of the long-term model of institutionalization,” says pharmacist Glalco Cyriaco, director of the Juquery Hospital Complex since 2010, when it held 260 residents. He believes that in a few years, there will be no more patients living there.

Most of the 60 buildings are unoccupied and closed, some with walls that are cracked or stained with mold – the building where the director’s office is located has still not been renovated after being destroyed by a fire in 2005 –  awaiting determination of a future use. According to architect Pier Paolo Bertuzzi Pizzolato, director of the archives, the master plan provides for a public university to occupy most of the buildings that are empty today and for construction of a physical therapy center for patients who require long term hospitalization. The as-yet-unfunded renovation project also includes the construction of gardens with fruit-bearing trees and flower beds on the old walled patios that separated the pavilions of the psychiatric hospital.

Scientific articles
GALVANESE, A. T. C. et al. Arte, saúde mental e atenção pública: Traços de uma cultura de cuidado na história da cidade de São Paulo. História, Ciências, Saúde – Manguinhos. V. 23, No. 2, pp. 431-52. 2016.
SCOPE, A. et al. A qualitative systematic review of service user and service provider perspectives on the acceptability, relative benefits, and potential harms of art therapy for people with non-psychotic mental health disorders. Psychology and Psychotherapy. On-line. 2016.

Books
LIMA, E. A. Arte, clínica e loucura: Território em mutação [Art, clinical practice and madness: a changing field]. São Paulo: Summus Editorial/FAPESP. 2009.
FERRAZ, M. H. C. de T. Arte e loucura: Limites do imprevisível [Art and madness: limits of the unexpected]. São Paulo: Lemos Editorial. 1998.

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