ORIGINAL ARTICLE

MANUAL FOR NURSES CARING FOR PSYCHOPATHS: 1932–1935

Johnny Lima Brandão1, Vitor Gomes de Faria2, Tais Veronica Cardoso Vernaglia3, Francisco Javier Castro Mollina4, Claudia Labriola5, Fernando Porto6

1 Universidade Federal do Estado do Rio de Janeiro (UNIRIO), Centro de Ciências Biológicas e da Saúde. Rio de Janeiro, RJ, Brazil. ORCID: 0000-0003-4039-8079. E-mail: johnnylimab.jlb@gmail.com.

2 Universidade Federal do Estado do Rio de Janeiro (UNIRIO), Centro de Ciências Biológicas e da Saúde. Rio de Janeiro, RJ, Brazil. ORCID: 0009-0009-6350-6782. E-mail: vitor.fariafg18@gmail.com.

3 Universidade Federal do Estado do Rio de Janeiro (UNIRIO), Centro de Ciências Biológicas e da Saúde. Rio de Janeiro, RJ, Brazil. ORCID: 0000-0003-3391-7301. E-mail: tais.vernaglia@unirio.br.

4 Universidad de La Laguna (ULL), Escuela de Enfermería Nuestra Señora de Candelaria. Santa Cruz de Tenerife, Tenerife, España. ORCID: 0000-0001-6068-9178. E-mail: fcastro@ull.edu.es.

5 Universidade Federal do Estado do Rio de Janeiro (UNIRIO), Centro de Ciências Biológicas e da Saúde. Rio de Janeiro, RJ, Brazil. ORCID: 0000-0002-8418-8359. E-mail: claudialabriola@unirio.br.

6 Universidade Federal do Estado do Rio de Janeiro (UNIRIO), Centro de Ciências Biológicas e da Saúde. Rio de Janeiro, RJ, Brazil. ORCID: 0000-0002-2880-724X. E-mail: ramosporto@openlink.com.br.

ABSTRACT

Objective: To analyze the content of the work, with emphasis on nursing professionals as strategic agents for physicians to establish themselves in the field of psychiatry, in support of mental hygiene and eugenics. Method: Documentary analysis of the Manual for Nurses Caring for Psychopaths, based on a microhistorical approach. Results: Nine chapters were written by individual authors, including eight male physicians (88.8%) and one female physician (11.2%). The content addressed neuroses, drug addiction, semiology, surgery, and gynecology, among other topics. The Manual prescribed technical and behavioral practices for nurses, aligning with the implementation of a hygienist and eugenicist social project. The work demonstrates the instrumentalization of nursing as the operational arm of psychiatry, within a context of disputes between training models and the definition of care profiles. Conclusion: The publication, through several articles, established the spokespersons for psychiatric care in Brazil and identified nursing as a strategic agent in the establishment of the medical profession within the Brazilian psychiatric field.

Descriptors: Psychiatry; History of Nursing; Mental Disorders; Nursing; Manuals as Topic.

What is already known:

• Mental illnesses were understood as threats to society;

• Mental hygiene and eugenics emerged as the operational arm of the theory of degeneration;

• The Brazilian League of Mental Hygiene played an important role in the context of Brazilian psychiatry during the first half of the twentieth century.

What this article adds:

• The chapters described nursing as a strategic means for the psychiatric field, based on the logic of mental hygiene and eugenics.

• The Manual inculcated sociocultural behaviors that reshaped care in institutions intended for psychiatric hospitals and asylums.

• Analysis of the Manual reveals professional disputes concerning training models and the definition of the nurse’s profile for psychiatric care.

INTRODUCTION

In the second half of the nineteenth century, psychiatry was influenced by Bénédict Augustin Morel’s theory of degeneration, according to which mental illnesses were transmitted across generations, causing the progressive degradation of the human species(1). When combined with eugenic ideals emerging in the early twentieth century, this perspective led mental illnesses to be understood as a threat to society and to supposed racial purity, thereby justifying social policies of control and prevention(2-3).

Based on the perceived need to prevent the development of possible forms of degeneration, mental hygiene emerged, motivated by the publication of Clifford Beers’ work in 1908. This movement sought to develop ways of treating and preventing mental illnesses and those affected by them, who at the time were referred to as psychoses and psychopaths, respectively, terms derived from the Greek words psyché and pathos. This perspective resonated among Brazil’s intellectual elite and was consistent with the theory of degeneration(4).

From this perspective, physician Gustavo Kohler Riedel founded the Brazilian League of Mental Hygiene (LBHM) in Rio de Janeiro in 1922, and the following year it was recognized as being of public utility by the Federal Government through Decree No. 4,778/1923(5).

In 1928, the League restructured its governing body into the positions of president, vice president, secretary, and executive council, with positions rotating every four years and held by establishments, institutions, and civilians over 18 years of age, without distinction based on gender(6).

The publication comprised the following sections: dispensaries and social assistance; hospital care for psychopaths; social legislation; forensic medicine and delinquency prevention; education and professional work; teaching and dissemination of neuropsychiatry; military hygiene; propaganda and advertising; childcare and child hygiene; medicine in its relations with the nervous system; surgery in its relations with the nervous system; and applied psychology and psychoanalysis(6).

On April 15, 1929(7), physician Ernani Lopes—director of the League and professor of Therapeutic Techniques at the Alfredo Pinto Professional School of Nurses—indicated the need to prepare a manual in Portuguese specifically for nurses caring for psychopaths, given the existence of manuals in other languages that would need to be translated. His proposal was supported by Pedro Pernambuco Filho, Mário Pinheiro, and José Leme Lopes, who proposed the development of an original work by the League.

Accordingly, Leme Lopes and José Valente Collares Moreira(7) organized the chapters for publication in the ABHM to instruct nurses working in psychiatric hospitals, asylums, and similar institutions between 1932 and 1935. The work was entitled “Manual for Nurses Caring for Psychopaths”.

Despite the recognized importance of the LBHM to Brazilian psychiatry and the dissemination of mental hygiene, a historiographical gap remains concerning the manuals produced by the institution for nursing education. Specifically, the Manual for Nurses Caring for Psychopaths remains little explored as a historical source revealing technical prescriptions, power relations, and the hygienist and eugenicist social project that guided psychiatric care in Brazil during the first half of the twentieth century. Analysis of the document makes it possible to understand how nurses were instrumentalized as strategic agents contributing to the consolidation of psychiatry as a field of knowledge and power.

Accordingly, as the first operation of scale reduction in the study(8), we established the following guiding question: “How did the content of the Manual for Nurses Caring for Psychopaths of the Brazilian League of Mental Hygiene articulate psychiatric knowledge, technical prescriptions, and the eugenicist project for nursing professionals?”

In view of the foregoing, the object of analysis was the Manual for Nurses Caring for Psychopaths, with the objective of analyzing the content of the work, with emphasis on nursing professionals as strategic agents for physicians to establish themselves in the field of psychiatry, in support of mental hygiene and eugenics.

METHOD

This is a documentary analysis within the domain of institutional history and the dimension of cultural history, conducted using a microhistorical approach, in which the object is examined within a specific sociocultural context and reduction in scale enhances its analytical capacity(9). Accordingly, the approach emphasizes detail, evidence, and the reconstruction of relationships on a reduced scale, without excluding collective or institutional objects.

The historical documents consisted of issues of the LBHM periodical through which the Manual for Nurses Caring for Psychopaths was disseminated. The search was conducted in the Digital Library of the National Library Foundation of Brazil, the digital collection of the Mental Hygiene and Eugenics Study and Research Group at the State University of Maringá, and the Alexandre Passos Library of the Documentation and Memory Center of the Nise da Silveira Municipal Institute.

The following criteria were adopted: inclusion—chapters intended for the Manual; and exclusion—advertisements and content unrelated to the object of study.

Data were collected using a structured instrument comprising the following variables: year of publication; location of the work; chapter title; authorship; author’s professional training; summary of the author’s career trajectory; and chapter summary. The data were organized chronologically in a spreadsheet using Microsoft Excel software.

The analysis of the documentary corpus began with an exploratory reading to gain an overall understanding of the works, regarding them as historical sources capable of enabling the reconstruction of versions and narrative interpretations of events(10). Subsequently, an extraction and data-tabulation matrix was completed based on the text of each chapter. Following this mapping stage, the researchers conducted a comparative analysis of the data and discussed the findings, taking into account the chronological evolution of the sources and comparing the findings with relevant literature on the history of psychiatry and nursing, as articulated with the trajectory of care provided to psychopaths.

The study did not require review by a Research Ethics Committee, in accordance with Brazilian National Health Council Resolution No. 510/2016(11), because it involved research based on historical documentary sources that did not involve living human participants.

Regarding limitations, the study was constrained by its dependence on the documentary corpus available in newspaper archives and specialized digital collections, which limited the analysis to the issues located, preserved, and accessible at the time of data collection. Furthermore, the analysis focused on the prescriptive discourse contained in the Manual, without access to how nurses received or implemented its content in the daily life of psychiatric institutions. This constitutes an inherent limitation of the nature of the source and points to avenues for future research. Nevertheless, the investigation maintained methodological coherence and analytical rigor by focusing on the documentary set effectively retrieved, in accordance with the proposed objectives.

RESULTS

Table 1 presents nine chapters and their respective authors. Of these, eight (88.8%) were authored by men, and only one (11.2%) was written by a woman, with no repetition among the authors.

Table 1 – Chapters of the Manual for Nurses Caring for Psychopaths. Rio de Janeiro, RJ, Brazil, 2026

Source: Adapted from ABHM, 1932.

Note: It should be noted that the chapter titles retain the original spelling used in the publications of the Arquivos Brasileiros de Higiene Mental.

Production was concentrated in the 1933–1934 biennium, with six of the nine publications, followed by a decline in 1935, when publication of the Arquivos Brasileiros de Higiene Mental was discontinued. The initial chapters addressed clinical and general topics, whereas, as the work progressed, the texts became increasingly specific, suggesting a shift from the macro to the micro level. The authors were trained in medicine and worked either in psychiatric care or in teaching, contributing to the training of new medical, nursing, and related professionals.

DISCUSSION

The Manual in the Context of Professional Disputes over Nursing

Between 1890 and 1935, several educational institutions were established to promote nursing education in Brazil, totaling five in Rio de Janeiro, six in São Paulo, and two in Bahia(21-22). The 1920s were marked by the effects of the public health movement and the influence of the model adopted from the United States of America, subsidized by the Rockefeller Foundation. Adapted from the Nightingale model, this approach was not specifically aimed at caring for people with mental illnesses but rather at public health. Nevertheless, it is noteworthy that the Professional School of Nurses (EPEE) was affiliated with the National Hospital for the Insane (HNA) and had renowned psychiatrists among its faculty, including members of the LBHM, such as Ernani Lopes, Gustavo Riedel, and Oscar Ramos(23).

During the 1920s, there was a dispute within the medical field. On one side were public health physicians allied with the American nurse Ethel Parsons—superintendent of the National Department of Public Health and affiliated with the nursing educational institution bearing the same name. On the other were psychiatrists, who advocated a modus operandi for nursing education emphasizing psychiatry, including debates concerning gender in the provision of care(24).

It is important to recall that the enactment of Decree No. 20,109/1931 changed the name of the former School of Nurses of the Department of Public Health to Anna Nery School of Nurses, which became the standard model for nursing education in Brazil, based on the model adopted by American nurses. In contrast, the EPEE, now the Alfredo Pinto School of Nursing, never achieved equivalent status because it followed the influence of the Franco-German model.

The Manual as a Eugenicist Disciplinary Instrument

The analysis therefore begins with aspects of the content of the LBHM’s Manual for Nurses Caring for Psychopaths. It provides indications that this may have been the first Brazilian work produced by an institution specifically for nurses caring for psychopaths. This assertion is based on evidence of the existence of other works at the time(25-28).

As can be identified, all of these works had single authorship, in contrast to the League’s work, which brought together nine specialists. This distinction is relevant because of the multiple perspectives involved, including from a gender perspective—eight men and one woman—who worked at the Colleges of Medicine of Rio de Janeiro (FMRJ), Fluminense School of Medicine (FFM), and the Rio de Janeiro College of Law, as well as at the Normal School and the EPEE, with the purpose of instilling a culture of care for the provision of nursing care to psychopaths.

The chapters published in the League’s journal conveyed credibility through a doctrinal vehicle for mental hygiene and eugenics(29). To this end, they promoted concepts aimed at controlling individual, school, professional, and social activities. This implied disseminating neuropsychic hygiene standards among the popular classes, within the framework of the cultural circulation of knowledge presented in the journal’s first issue (1925), directed toward morality with a universal vision of the future(30).

Research at the time addressed topics such as criminality, psychophysiology, hypochondria, sexuality, physical and moral education, hygiene and mental illness, hysteria, and other subjects related to psychiatry and social medicine. These were recognized as forms of psychological knowledge in the care of people with mental illnesses and as capable of determining what was (a)normal under different social conditions(28). Thus, the creation of norms was of interest to the field of psychiatry, supported by a discourse aimed at improving care, particularly care related to readmissions(28,30).

As can be identified, mental hygiene and eugenics, as articulated in the Manual, were intended to convey their message to readers and, particularly, to nursing professionals responsible for caring for psychopaths. Their purpose was to instill sociocultural behaviors through nurses in order to reconfigure care in institutions intended as asylums and psychiatric hospitals. The term manual is consistent with Collière’s account(31), in the sense of instilling behaviors or training individuals. This led us to infer that the League sought to internalize values, beliefs, norms, customs, and behaviors, resulting in enculturation(32) for practice within the psychiatric context.

Analysis of the Chapters

As the Manual was published in installments in the LBHM journal, it is worth noting that the final chapter coincided with the beginning of one of the periods during which publication of the ABHM was suspended, resuming in 1938 under the direction of Henrique Roxo(33).

The first chapter, authored by Julio Pires Porto-Carrero, focused on mental neurosis. At the time, the author was vice president of the LBHM and a representative of psychoanalysis in Brazil. He addressed the concepts of anxiety, impulse, idea, and action, articulating them to explain neuroses, which he defined in his text as illnesses arising from abnormal behavior and motivated by distressing and unrealistic or absurd and neurotic ideas, while preserving intelligence and orientation but without delusions. He also described symptomatic, physical, and psychological treatments, stating that the nurse was a valuable assistant in medical interventions(12).

Considering nurses as providers of treatment, understood as care, recalls the debate concerning the preference for women over men, except in the field of psychiatry. The idealization of the professional image was grounded in characteristics attributed to women—docility, maternal qualities, and education, for example—as suitable for working in hospitals, particularly during discussions at the Latin American Medical Congresses (1904–1909), in contrast to their role in asylums and psychiatric hospitals(34).

The arena for debate at the Latin American Medical Congresses was the discussion surrounding male and/or female personnel for providing care to psychopaths. Several moments were complex because different groups had their own interests, particularly concerning which gender was considered more suitable for providing care(34-37).

On one side, the discussion favored the training of female nurses according to the Florence Nightingale model, to the detriment of male nurses, under the leadership of Cecilia Grierson, an Argentine physician. On the other side, Juliano Moreira, director of the HNA, advocated for both genders, emphasizing that men were indispensable in caring for psychopaths. This position was based on experiences in asylum and similar institutions in Germany, Scotland, Switzerland, Belgium, and the Netherlands, while another group attempted to reconcile the debate by arguing that the appropriate gender depended on the setting in which care was provided(34-37).

The subsequent chapter, written by Heitor Pereira Carrilho, addressed the environment of the Judicial Asylum. This type of institution was intended for so-called delinquent psychopaths and was described by Carrilho as a social defense institution designed to address delinquency through the prescription of therapeutic care and social segregation(12). The first such unit in Brazil was established in Rio de Janeiro in 1921, replacing the Lombroso Section of the HNA, under the direction of the author, who was then responsible for the District Federal Service for Delinquent Insane Patients(38).

According to the author, nurses working in a judicial asylum should have knowledge of the psychology of the patients under their supervision, as well as feelings of compassion or pity to improve the morale of those hospitalized. His text categorized psychopaths as constitutional amoral individuals, paraphrenics, schizophrenics, manic patients, alcoholics, and others, in order to guide nurses. Carrilho also emphasized that nurses should be prepared for patients’ reactions, including escape attempts, aggression, possession of improvised weapons, riots, suicide, homosexual practices, absconding, and the fraudulent sending and receipt of correspondence(13).

The concepts of compassion and pity bring to mind the two marble statues on the entrance staircase of the former HNA, now part of the Federal University of Rio de Janeiro campus at Praia Vermelha, in Rio de Janeiro. The first, entitled “Sciences”, symbolizes science, higher education, and culture within the university’s academic environment; the second, entitled “Educating Charity”, by Lorenzo Bartolini, evokes compassion for the sick and was executed in the Neoclassical style by Ferdinand Pettrich in the mid-nineteenth century(39).

These are symbolic markers whose meanings have varied over time. We understand them as an example of an evidentiary paradigm(8), in which the iconographic record functions as a message that can be articulated with the attributes described in Carrilho’s chapter concerning the 1930s. They also constituted one of the strategies for making people believe and see(40), reminding those unfamiliar with the institution that both the institution and its staff were expected to adhere to these principles in their actions.

The following chapter, authored by Faustino Esposel, was published after his death(13). A professor of neurology at the FFM(41) and a hygiene lecturer at the Normal School, he held the positions of acting president and vice president of the LBHM, as well as serving on its executive council and in the 6th study section, which focused on the teaching and dissemination of neuropsychiatry(42).

His text presents concepts of neurological semiology, covering the patient history and physical examination in an objective manner, with emphasis on physiology, neurology, and motor function. It also favors the nurse, rather than the male nurse, as being better prepared to collect information about the patient for the physician, thereby acting as the physician’s assistant(14). This points to a gender-based division of labor, in which women were assigned the “lighter” work, resembling that of a secretary, while men were assigned more “manual” care requiring physical activity.

Understanding the doctrinal emphasis based on physiology, neurology, and motor function brings to mind the works O Livro do enfermeiro e da enfermeira para uso das pessoas que se destinam à profissão de enfermeiro e das pessoas que cuidam de enfermos(26) and Curso de enfermeiros(27), which presented similar content, either directly or indirectly. The latter also documented the author’s travels in Europe, during which he prepared a report on various aspects of nursing entitled “Uma viagem à Europa”(43), recording how care was provided in several institutions in France, England, and Germany, for example. Thus, we infer that the LBHM intended to establish its position within the field of psychiatry through this and the other contents, while also reaffirming foundational knowledge from the perspective of its specific area of interest.

The chapter by Juliano Moreira, honorary president of the LBHM(42) and patron of the Euphoria Clinic(44), was also published after his death(15). A disseminator of psychoanalysis(45) and an important figure in the Brazilian psychiatric landscape(46), his text refers to the ideas of Belgian physician Jules Morel, author of Manuel des gardes-malades dans les hôpitaux pour maladies mentales, published in 1907(15). In this work, we find the attributes considered necessary for nurses caring for psychopathic patients and for the so-called “patient attendants”, from the French gardes-malades, as described by Morel. According to him, nurses should follow medical orders with submission and subservience(24).

The term “attendant” attributed to the nurse in Moreira’s text, based on Morel, is applied in the sense of surveillance, for example, as one of the elements of the art of nursing in earlier times, when this professional was responsible for ensuring the tranquility and safety of hospitalized patients within the institution, as exemplified by European establishments where such care was provided(47).

On the one hand, some professionals tended toward brutality in their actions, as exemplified by a head nurse—João Batista—at the Raul Soares Institute in Minas Gerais, who had a robust physique and practiced boxing and used aggressive physical force to maintain order. This led to his dismissal, along with that of others who exhibited similar conduct, by the institution’s director, Hermelino Lopes Rodrigues(48). This reinforces the imagery represented by the statues on the staircase of the former National Hospital for the Insane—Science and Charity—which is consistent with the principles that should be followed, as articulated in Carrilho’s chapter. Thus, the Manual did not advocate violence but rather prescribed attributes of science and charity for nurses; on the other hand, these expectations could challenge the masculine performance associated at the time with an “adamado” identity(49).

The fifth chapter begins with a discussion centered on the agitated psychopath(16) and was authored by Odilon Gallotti, a member of the LBHM’s 6th study section and a lecturer at the FMRJ and the Professional School of Nurses (EPEE)(42). In his text, he states that nurses caring for patients in an agitated state should report clinical events to the physician to guide treatment, including bed rest, hydrotherapy, sedative pharmacotherapy, and isolation(16).

Adolpho Possollo, in his work(27), which was explicitly linked to the EPEE curriculum, presents hydrotherapy, for example, in the chapter entitled “Special care for certain categories of patients and balneotherapy”. These procedures included immersion baths, showers (cold, column showers, spray or circular showers, movable jets, Scottish showers, and steam showers), Roman baths, steam baths, and Russian baths. He also taught how an inpatient should be restrained in cases of agitation, providing numerous illustrations to facilitate understanding of the actions to be taken.

Adolpho Possollo’s work(27) was intended for general nursing but at certain points focused on psychopaths, given that the educational institution was responsible for training personnel to work in civilian and military hospitals, asylums, and psychiatric hospitals, in accordance with Decree No. 791/1890, which established the Professional School of Nurses. This differed from the Manual produced by the LBHM.

The sixth chapter was written by Pedro Pernambuco Filho, superintendent of school hygiene and a member of the LBHM’s 2nd study section. In his text, the author focused on users of psychoactive substances, referred to as toxicomaniacs, while also reinforcing attributes considered inherent to nurses, such as solicitude, kindness, understanding, vigilance, patience, and proper language use(17).

The emphasis placed in the text on nurses’ moral attributes suggests the need to reaffirm these characteristics in response to the use of physical force or similar practices, as previously mentioned, which tarnished the reputation of the care provided. It is worth noting that discussions concerning men in nursing had already taken place at the Latin American Medical Congresses, where the prevailing view was one of conditional permissibility. Thus, men were welcome provided that they had a profile associated with femininity, being described as “adamados”, and did not hold administrative positions or exercise administrative authority(22).

The seventh chapter, written by surgeon and member of the LBHM’s 11th study section(42), Oscar Ramos, addresses surgery(18). The physician presents surgery as a delicate and arduous field, but argues that nurses should have sufficient knowledge to provide specific care, ranging from preparing the environment and patient for the surgical procedure to physical examination, dressing changes, and related procedures.

Preoperative, intraoperative, and postoperative care was important because psychopaths could also experience health conditions requiring intervention. This type of intervention received attention in the Manual because these individuals were hospitalized in asylums and psychiatric institutions and required specific approaches in certain situations. In any case, the works of Getulio dos Santos(26) and Adolpho Possollo(27) addressed similar aspects, as did the English- and Spanish-language works by the nursing authors Maxwell and Pope(50,51). Nevertheless, the organizers and authors of the LBHM work sought to establish a distinct position by arguing that these patients were in particular conditions.

In turn, the eighth chapter, written by Argentine physician Juana Mancusi de Lopes, a gynecological surgeon in the women’s section of the HNP and a member of the LBHM’s 11th study section, addresses exclusively female psychopaths and gynecological conditions that could arise during hospitalization(19). She described signs and symptoms requiring nurses’ attention, such as discharge, odor, itching, and foreign bodies, and also provided guidance on examinations, psychotherapy, and menstruation.

This is the only chapter in the work that exclusively addresses women throughout all the chapters published as articles in the ABHM, whether in the role of nurse or patient. This is noteworthy because of its distinctive character and may be explained not only by the fact that the author was the only woman in the Manual or by her specialization in gynecology, but also by her favorable position toward the ideological view of nursing as an exclusively female domain(21). In addition, it should be considered that women’s bodies have historically been shaped by taboos and gender biases which, at the time, reinforced attempts to control their bodies and also indicated who could have access to this field(52).

This brings us to nursing education, where a record exists of a censored illustration in Adolpho Possollo’s work, in the 1920 edition reissued in 1938, concerning male catheterization, with the image of the catheter in the penis omitted, as well as an illustration of dressing technique in the scrotal region. This was found in a copy acquired for the collection of the Nursing and Nutrition Sector Library of the Federal University of the State of Rio de Janeiro and was considered a form of censorship, even in the restricted sense of determining who was entitled to access the work for study(53).

In this sense, considering the body in earlier times meant maintaining moral order and ensuring that men and women would not have access to the bodies of the opposite sex, as a means of preserving good morals. Lopes(19) draws attention to the fact that, in the context of gynecological and obstetric clinical care, male nurses should not have information about women’s complaints or similar situations, nor about women’s internal and external organs.

Finally, physician Januário Bittencourt—assistant in psychopath care and a member of the LBHM’s anti-alcohol commissions—presented the chapter entitled “Notions on the etiology of mental illnesses for a nursing course”(20). In it, the author described the various etiologies of mental disorganization. This makes clear that the target audience of the Manual for Nurses Caring for Psychopaths was nursing professionals, despite the predominantly masculine grammatical form used throughout the text.

The Manual for Nurses Caring for Psychopaths was a tool developed to reaffirm a social project based on mental hygiene and eugenics, emphasizing efficiency, rationalization, and control(54), with a focus on the care of psychopaths.

CONCLUSION

The study analyzed the content of the work, with emphasis on nursing professionals as strategic agents through whom physicians established themselves in the field of psychiatry, in support of mental hygiene and eugenics. It demonstrated how nurses were to be instrumentalized by the psychiatric elite as strategic agents in the consolidation of a hygienist and eugenicist social project.

Analysis of the documentary corpus yielded three main findings: the Manual constituted the first Brazilian institutional work specifically intended for psychiatric nursing, linking technical prescriptions to a broader project of social regeneration; the work reveals a dispute within the health field between the public health and psychiatric models, with the LBHM using nursing as an instrument for demarcating professional territory; and, finally, the Manual conveyed a professional ethos based on attributes such as submission, vigilance, compassion, and patience, shaping the nurse’s profile to meet the needs of the asylum system.

By analyzing the Manual as a historical source, this study contributes to the historiography of nursing by revealing the mechanisms of discipline and enculturation through which nursing was shaped to serve the interests of the medical elite. The analysis demonstrates that manuals, beyond prescribing techniques, function as vehicles for sociopolitical projects and are therefore fundamental to understanding the power relations underlying psychiatric care in Brazil during the first half of the twentieth century. These findings may also help elucidate professional hierarchies in mental health care embedded in contemporary practice.

A limitation of the study was the inability to access how the Manual was received and implemented by nurses in the daily life of psychiatric institutions, pointing to the need for future research comparing prescriptive discourse with actual care practices. Furthermore, the focus on documentary content, without exploring its circulation and appropriation among professionals of the period, calls for further investigations in the field of the history of psychiatric nursing.

Examining documents such as manuals makes it possible to uncover the mechanisms underlying care beyond the provision of care itself, that is, the cultural mentality that was established. Thus, such analysis provides an opportunity to investigate and construct alternative versions and interpretations of what the past has left behind, inviting reflection on attitudes and practices in contemporary care and, ultimately, enabling new meanings to be attributed within the historiographical field.

ACKNOWLEDGMENTS

We thank Mr. Caio Luiz Rosário de Assis and the Laboratory of History of Nursing, Care, and Image (LACUIDEN) for their collaboration during the data interpretation phase. We also thank the Documentation and Memory Center of the Nise da Silveira Municipal Institute for its support with historical documentation.

CONFLICT OF INTEREST

The authors declare no conflicts of interest.

FUNDING

This study was carried out with the support of the Coordination for the Improvement of Higher Education Personnel – Brazil (CAPES) – Funding Code 001.

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Submission: 25-May-2026

Approved: 15-Jul-2026

Editors:

Rosimere Ferreira Santana (ORCID: 0000-0002-4593-3715)

Geilsa Soraia Cavalcanti Valente (ORCID: 0000-0003-4488-4912)

Gicelle Galvan Machineski (ORCID: 0000-0002-8084-921X)

Corresponding author: Johnny Lima Brandão (johnnylimab.jlb@gmail.com)

Publisher:

Escola de Enfermagem Aurora de Afonso Costa – UFF

Rua Dr. Celestino, 74 – Centro, CEP: 24020-091 – Niterói, RJ, Brazil

Journal email: objn.cme@id.uff.br