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Casa De Oswaldo Cruz – FIOCRUZ Programa De Pós-Graduação Em História Das Ciências E Da Saúde Casa de Oswaldo Cruz – FIOCRUZ Programa de Pós-Graduação em História das Ciências e da Saúde GIULIA ENGEL ACCORSI SÍFILIS, LOUCURA E CIVILIZAÇÃO: A PARALISIA GERAL PROGRESSIVA E A INSTITUCIONALIZAÇÃO DO CAMPO NEUROPSIQUIÁTRICO NO RIO DE JANEIRO (1868-1924) Rio de Janeiro 2020 GIULIA ENGEL ACCORSI SÍFILIS, LOUCURA E CIVILIZAÇÃO: A PARALISIA GERAL PROGRESSIVA E A INSTITUCIONALIZAÇÃO DO CAMPO NEUROPSIQUIÁTRICO NO RIO DE JANEIRO (1868-1924) Tese de doutorado apresentada ao Curso de Pós-Graduação em História das Ciências e da Saúde da Casa de Oswaldo Cruz-Fiocruz, como requisito parcial para obtenção do Grau de Doutor. Área de Concentração: História das Ciências. Orientadora: Profa. Dra. Cristiana Facchinetti Coorientador: Prof. Dr. André Felipe Cândido da Silva Rio de Janeiro 2020 II GIULIA ENGEL ACCORSI SÍFILIS, LOUCURA E CIVILIZAÇÃO: A PARALISIA GERAL PROGRESSIVA E A INSTITUCIONALIZAÇÃO DO CAMPO NEUROPSIQUIÁTRICO NO RIO DE JANEIRO (1868-1924) Tese de doutorado apresentada ao Curso de Pós-Graduação em História das Ciências e da Saúde da Casa de Oswaldo Cruz-Fiocruz, como requisito parcial para obtenção do Grau de Doutor. Área de Concentração: História das Ciências. BANCA EXAMINADORA ___________________________________________________________________________ Profa. Dra. Cristiana Facchinetti (Programa de Pós-Graduação em História das Ciências e da Saúde – Casa de Oswaldo Cruz- Fiocruz) – Orientadora ___________________________________________________________________________ Prof. Dr. André Felipe Cândido da Silva (Programa de Pós-Graduação em História das Ciências e da Saúde – Casa de Oswaldo Cruz- Fiocruz) – Coorientador ___________________________________________________________________________ Prof. Dr. Sérgio Luis Carrara (Programa de Pós-Graduação em Saúde Coletiva – Instituto de Medicina Social-UERJ) ___________________________________________________________________________ Prof. Dr. André Mota (Programa de Pós-Graduação em Saúde Coletiva – Departamento de Medicina Preventiva- FMUSP) ___________________________________________________________________________ Profa. Dra. Ana Teresa Acatauassú Venâncio (Programa de Pós-Graduação em História das Ciências e da Saúde – Casa de Oswaldo Cruz- Fiocruz) ___________________________________________________________________________ Prof. Dr. Flávio Coelho Edler (Programa de Pós-Graduação em História das Ciências e da Saúde – Casa de Oswaldo Cruz- Fiocruz) III Suplentes: ___________________________________________________________________________ Profa. Dra. Dilene Raimundo do Nascimento (Programa de Pós-Graduação em História das Ciências e da Saúde – Casa de Oswaldo Cruz- Fiocruz) ___________________________________________________________________________ Profa. Dra. Ana María Jacó Vilela (Programa de Pós-graduação em Psicologia Social – UERJ) Rio de Janeiro 2020 IV FICHA CATALOGRÁFICA V Para os Engel e os Accorsi – meus amores absolutos que durante esses quatro anos permaneceram unidos, apesar das distâncias e das doenças. VI AGRADECIMENTOS Apesar de redigido solitariamente, o presente estudo não teria sido possível sem a ajuda, a generosidade e o carinho de dezenas de pessoas. Agradeço à minha orientadora Profa. Dra. Cristiana Facchinetti e ao meu coorientador Prof. Dr. André Felipe Cândido da Silva, por terem caminhado ao meu lado durante todo o processo de desenvolvimento desta tese; por toda a compreensão que tiveram e pelo apoio incondicional e carinho que me deram no momento em que mais precisei de acolhimento. Às Professoras Simone Petraglia Kropf e Nara Azevedo e aos Professores Luiz Otávio Ferreira e Gilberto Hochman, sem cujas aulas a minha conversão da biologia para a história teria sido impossível. Ao meu querido trio, companheiro dessa jornada doutoral, Erika Marques de Carvalho, André Luís de Almeida Patrasso e Lucas Lolli Vieira, com quem pude dividir angústias e conquistas. A Amanda Guterrez, Maria Claudia Cruz, Paulo Chagas e Sandro Hilário do Programa de Pós-Graduação em História das Ciências e da Saúde da Casa de Oswaldo Cruz, pelo cuidado que dedicam aos alunos do programa e pela ajuda que recebi em momentos de desespero para o cumprimento de prazos e trâmites burocráticos. A Maria Cláudia Santiago, Tarcila Peruzzo e Iara Amorim, da Biblioteca de Obras Raras da Fiocruz. A Cátia Maria Mathias, colega de pós-graduação e chefe da Biblioteca Professor João Ferreira da Silva Filho (IPUB/UFRJ). A Ana Lúcia Albano, da Bibliotheca Gonçalo Moniz da Faculdade de Medicina da Bahia. A todas essas profissionais, um “muito obrigada” especial – sem seu conhecimento, grande parte das fontes aqui analisadas teriam permanecido inacessíveis. Aos meus pais, Magali e Paulo, pela inspiração diária. À minha avó Clarinha, aos meus padrinhos Gueti e Beto e à minha tia Simone, pelo apoio e carinho absolutos. Ao meu irmão Luigi e à minha cunhada Nicole, pela lembrança cotidiana de que eu conseguiria chegar até aqui. Ao meu primo Marcel, há trinta anos me mantendo longe das janelas do 7º andar e firme na disputa de quem é o preferido da vovó. Aos meus pais e mãe do coração, André Fonseca, Edson Fabrin e Mônica Maccachero, porque melhor do que ter dois é ter cinco. Às minhas amigas Dominique Assis, Júlia Aguillar, Juliana Valle e Ludimila Melo, e ao meu amigo Leandro Lee, que me apoiaram em diferentes momentos, se prontificando a me ouvir desfiar uma infinidade de rosários sobre as minhas dificuldades com a tese. À minha supervisora do Programa de Doutorado Sanduíche no Exterior, Dra. Gayle Davis, pelas discussões sobre a pesquisa, pelo incentivo e encorajamento que transformaram para sempre a minha trajetória enquanto pesquisadora. A Beatriz Lemos e Tiago Metello, por VII terem sido os primeiros a me acolherem em Edimburgo. A Gabriela Rolim e Marcelo Gidaro, por terem dado continuidade a esse processo de acolhimento como ninguém. A Marcela Delia, pela dedicação, pela paciência, pelas aventuras, enfim, por ter passado a fazer parte da minha vida. A Roberta Leotta, Inês Silva e Elisabeth Rébeillé-Borgella pelas risadas e pelo companheirismo inesquecíveis. A Arran Claringbold, Anna Lively, Claire Aubin, Gladys Mazloum, Hugo Zetterberg, Jackie Simard, James Bright, Jess Campbell, Kelli Conley, Linsey McMillan, Niccolò Aliano, Luísa Rodrigues, Marcela O’Meara, Marina Moya, Mila Daskalova e Monique DePace pelo acolhimento, receptividade e por todos os momentos de diversão. A Adam Budd, pela confiança em mim e nesta pesquisa. VIII “A biologia me ensinou a examinar uma área submetida à evolução sempre em sua história evolutiva [...] Da mesma maneira, qualquer teoria do conhecimento sem estudos históricos ou comparados permaneceria um jogo de palavras vazio, uma epistemologia imaginária (Epistemologia imaginabilis)”. Ludwick Fleck. Gênese e Desenvolvimento de um Fato Científico. [1935], 2010. IX RESUMO O trabalho discute como o processo de construção do diagnóstico da paralisia geral progressiva (PGP) influenciou a consolidação do campo neuropsiquiátrico no Rio de Janeiro. O recorte temporal inicia-se em 1868, data da publicação da primeira fonte identificada que aborda aspectos da referida doença. A investigação documental encerra-se no ano de 1924, quando passa a ser utilizado, no Rio de Janeiro, o primeiro tratamento considerado específico para a PGP, a malarioterapia. A análise contempla teses médicas, relatórios administrativos, livros e artigos publicados em diferentes periódicos. Conclui-se que a PGP fora enquadrada pelo campo neuropsiquiátrico carioca a partir da apropriação de ferramentas consideradas pela medicina geral como científicas e objetivas, em diferentes épocas. Os debates acerca dos contornos da enfermidade iniciaram-se articulados aos referenciais provenientes do campo da anatomia patológica, que floresceu durante o oitocentos, transformando a PGP na primeira doença mental que evidenciava a relação entre lesões materiais e sintomas clínicos, de acordo com o discurso de muitos médicos do período. Durante o novecentos, a sífilis ganhou papel de destaque como causa da PGP, aproximando as discussões sobre a última de temas como as teorias da degeneração e racializadas. Ao tomar parte nestas contendas, neuropsiquiatras buscavam conferir legitimidade social a sua especialidade, demonstrando seu valor no processo de construção de uma nação brasileira civilizada e saudável. Neste momento, a importância dos laboratórios ganhava proeminência na retórica destes profissionais e, mais uma vez, a PGP permitiu que ferramentas diagnósticas e terapêuticas consideradas mais objetivas pelos diferentes campos médicos fossem apropriadas por parte deles. Mesmo vitimando um número pouco significativo de indivíduos, a doença viabilizou o diálogo entre cientistas de diferentes especialidades. Ao discutir aspectos relacionados ao processo de construção do diagnóstico da paralisia geral progressiva, a presente tese pretende contribuir para o enriquecimento do arcabouço historiográfico relativo à história da psiquiatria no Brasil. X ABSTRACT This research discusses how the framing of general paralysis of the insane (GPI) engaged with the professionalization of neuropsychiatry in Rio de Janeiro. The investigation begins in 1868 when the first source that addresses aspects of the disease was published. It ends in 1924, when the first specific treatment for GPI, the malariotherapy, was put in practice in Rio de Janeiro. The analysis is mainly based on medical thesis, administrative reports, books, and articles published in different academic journals. This work concludes that PGP framing process occurred
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