| Visions of Psychiatry, Madness and the Republic in the
Work of Dr. Luís Cebola (1876–1967): An Historical Approach at the Crossroads
of Psychiatry, Ideology and Fiction in Portugal in the First Half of the
Furthermore, as Marijke Gijswijk and Harry Oosterhuis
have pointed out, the political framework of a particular historical moment and
the societal conditions of a nation must also be taken into account when
writing the history of psychiatry. The development and institutionalisation of
the psychiatric profession after the French Revolution, for example, was
associated with the rise of the bourgeoisie and the ideational ferment of the
Enlightenment. In consequence of these watershed factors, and until the
first-half of the twentieth century, the profession and its institutions served
two key functions: first, a medical one, i.e. the welfare and treatment of
patients and secondly, a socio-political one relating to the ultimate goal of
freeing society from the social and economic burden represented by the
population of the mentally ill. How these two functions influenced each other
varied from place to place, since they were intrinsically connected to a
country’s political and ideological environment.
In regard to the history of Portuguese psychiatry, it
is impossible to write on the evolution of this medical discipline and practice
without referring to the political background as it existed at the end of the
nineteenth and early twentieth centuries. Thus, at the beginning of the
twentieth century, Portuguese anti-monarchists were highly influenced by
Comte’s positivism: they held the belief that humanity would henceforth
participate in the so-called third stage of socio-political evolution, one that
would be dominated by the establishment of a scientific-secular faith. In
short, they believed that the new era of social organisation and development
would be securely founded on scientific knowledge. Consequently, pedagogy and
psychiatry became two of the sciences to which the First Portuguese Republic
gave particular attention after its establishment (following the overthrow of
the Portuguese monarchy) in 1910. The former was rightly considered to be
indispensable to the attainment of the Republic’s ideals and to develop the
citizenry’s civic sense, moral character, intellectual and cultural maturity
and physical health, while
the latter, devoted to brain research (the locus of mind and consciousness),
would provide the relevant knowledge necessary to better understand the nature
of social organisation and human behaviour. In this context, the historian of psychiatry,
as it has developed in Portugal, must consider the contributions made by the
following Portuguese doctors and psychiatrists: Júlio de Matos (1856–1922),
Miguel Bombarda (1851–1910) and Egas Moniz (1874–1955), who were actively
involved in the so-called Republican conspiracy and subsequent revolution of
1910. It should be noted that, after the establishment of the Republican
government, the abovementioned medical professionals, indeed the medical class
in general, became an influential presence in the Portuguese Parliament.
Notwithstanding the fact that only minor changes occurred in terms of
psychiatric care per se during the
first decades of the twentieth century, the years of the First Portuguese
Republic (1910-1926) were a fertile period with respect to the
institutionalisation and development of the psychiatric profession. Indeed,
following the establishment of the Portuguese Republic, the Provisional
Government established a constitution in 1911 which guaranteed the right to
health care for all citizens.
Nonetheless, psychiatry was still only lectured in free courses at the
beginning of the twentieth century. In fact, it was only on 22 February 1911,
as a result of a significant reform vis-à-vis medical training and teaching,
that the chairs of neurology, psychiatry and forensic psychiatry were
officially recognised as a regular part of the curriculum of the Portuguese
Faculties of Medicine.
On 11 May 1911, a law regulating the hospitalisation of psychiatric patients
was approved. This document authorised the government to establish seven new
psychiatric asylums and ten agricultural colonies with a view to the treatment
of the insane.
A brief clinical portrait of Luís Cebola and of the CST
José Luís Rodrigues Cebola was born in Alcochete on 5
September 1876. From
1899 to 1906 he studied medicine at the Escola Médico-Cirúrgica de Lisboa.
This School had been created in 1836 (replacing the earlier Escola Régia de
Cirurgia established in the Hospital Real de S. José in 1825 by King John VI
(D. João VI), and occupied the premises of a convent situated near the Hospital
de S. José.
Luís Cebola prepared his final
dissertation [his “tese inaugural”], A
Mentalidade dos Epilépticos [The Epileptics’ Mind], while working at the
Hospital de Rilhafoles (the first state-run psychiatric hospital created in
Portugal), under the supervision of Professor Miguel Bombarda (1851–1910).
Miguel Bombarda had been appointed director of this hospital in 1892 by the
Portuguese House of Commons and was also the Regent Professor of Physiology and
Histology at the Escola Médico-Cirúrgica de Lisboa from 1883.
Cebola’s work in Rilhafoles consisted in the analysis (in terms of appearance
and content) of works of art produced by epileptic patients with a view to
discovering an underlying psychopathological law.
According to Gameiro et al., Luís Cebola was
nominated clinical director of the Casa de Saúde do Telhal on 2 January 1911 by
the Governo Provisório da República Portuguesa [Provisional Government of the
Portuguese Republic], since he was deemed to be politically aligned with the
tenets of the new Republic and therefore an apt candidate to work in this
religious institution caring for the mentally ill.
Luís Cebola himself stated in his abovementioned autobiographical memoir that
it was his friend, the statesman Afonso Costa (1871–1937), then Head of the
Republican Government, who invited him to accept this position. He claims to
have accepted the invitation because he was a firm supporter of the new
political regime and considered it a way for him to be of service to his
He would remain the clinical director of this institution for the next
thirty-eight years, retiring only on 28 February 1949.
The CST, also known as Manicómio do Telhal or Casa do
Sagrado Coração de Jesus, affiliated with the religious brotherhood the Ordem
Hospitaleira de S. João de Deus (OHSJD), began to function as an insane asylum
in 1893. It was built on a farm in Sintra which had been purchased by Bento
Menni, an Italian member of the OHSJ.
The aim of this brotherhood was to create a hospital which exemplified the
humanitarian and spiritual vision of their patron saint, S. João de Deus.
Significantly, their policy was to keep abreast of, and use, the most
up-to-date international developments (both theoretical and technical
innovations) in the fields of medicine and psychiatry.
On 15 October 1911, Afonso Costa, then a
delegate of the recently instituted political regime, visited the CST. He
authorised the religious brotherhood to continue their work as male nurses on
condition that they stopped using clerical uniforms and that the institution be
subjected to detailed inspections carried out by government representatives.
Concomitantly, between October 1910 and April 1911, the Portuguese Republican
government abolished all references to Catholicism in public matters; on 20
April 1911, a decree was passed officially separating church and state. Under
this law, the Catholic Church’s patrimony became government property.
However, owing to the fact that Bento Menni had bought the farm under his own
name (and therefore could not be considered property belonging to the
brotherhood), the republican government could not claim rights over this
It should be noted that when the CST opened, there
were only two psychiatric hospitals in Portugal: the Hospital de Rilhafoles in
Lisbon and the Hospital do Conde de Ferreira in Porto. The former had begun to
function on 13 December 1848. It occupied the premises of the old
São Vicente de Paula Convent. Until then, mental patients had been hospitalised
at the Hospital Real de Todos os Santos (a general hospital) located in the
Rossio district of the city. Following its demolition in the aftermath of the
1755 earthquake, patients were transferred to the nursing facilities of S.
Teotónio and Santa Eufémia at the Hospital de S. José. The medical care was
very poor in these nursing facilities as a result of the dearth of specialised
medical staff and also to the overall poor quality of the facilities themselves.
In the northern Portuguese city of
Porto, the precarious conditions with regard to the care and treatment of
mental patients were similar to those seen in the capital. Until 1883, when the
first psychiatric hospital was created – the Hospital Conde de Ferreira – the mentally
ill were hospitalised in a general hospital. Its first director, António Maria
de Sena, published the hitherto most extensive study concerning the medical
care of the insane – Os alienados em
Portugal: História e Estatística [The Mentally Ill in Portugal: History and
In consequence of World War I, there
emerged a great number of military men needing psychiatric and clinical care.
The CST was subsequently selected by the Ministry of War to become a military
asylum. This was an important moment for the CST, since payments made by the
government enabled the improvement of the existing buildings, as well as the
construction of new ones.
During the 30’s, the CST would again be chosen by the Portuguese Military as a
health-care institution for their members requiring psychiatric treatment.
In 1936, a Nursing School was
founded at the CST.
Nurses’ education was supervised by Meira de Carvalho, who was hired as a
general practitioner there in 1931.
Luís Cebola stated that he himself was responsible for suggesting the creation
of this Nursing School to the hospital administration in 1925 in order to
improve the OHSJD nurses’ scientific knowledge in the areas of anatomy,
physiology, minor surgery procedures, pharmacology, hygiene and psychopathology.
Concurrently, a course on psychiatry was also given to the future nurses of the
OHSJD by Luís Cebola himself.
This private Nursing School became an official state institution in 1939,
thenceforth named the “Escola de Enfermagem S. João de Deus”,
which continued to operate at the CST until 1971
Programme in History, Philosophy and the Science and Technology Heritage.
Faculty of Science and Technology, New University of Lisbon, Portugal.
 Porter, Roy; Wright, David, The Confinement of the Insane: International
Perspectives 1800–1965 (Cambridge: Cambridge University Press, 2003), pp. 1–19.
 Andrew Scull, Social Order / Mental Disorder: Anglo-American
psychiatry in historical perspective (Berkeley:
University of California Press, 1989), p. 12.
 Jones, Kathleen, “The culture of Mental Hospitals”, in German Berrios, Hugh Freeman (eds.), 150 years of British
Psychiatry: 1841–1991 (London: Gaskell, 1991), p. 17.
 Scull, Social Order /
Mental Disorder, p.8.
 Marijke Gijswijt, Harry Oosterhuis, Psychiatric Cultures Compared: Psychiatry and Mental Health Care in the
Twentieth Century – Comparisons and Approaches (Amsterdam: Amsterdam
University Press, 2005), pp. 17–18.
 Fernando Catroga, O Republicanismo em
Portugal: da formação ao 5 de Outubro de 1910 (Lisboa: Notícias editorial,
2000), pp. 277–291.
 José Mattoso (dir.), História
de Portugal, 8 vols., Vol. 6: Rui Ramos, A Segunda Fundação (1890 –1926) (Lisboa: Edições Estampa, 1994), pp.
 Pimentel, Irene Flunser, “A Assistência social e familiar
de Estado Novo nos anos 30 e 40”, Análise
Social, 1999, XXXIV: 477–508 on p. 478.
Morgado Pereira, “ A psiquiatria no tempo da I república”, in Corpo: Estado, Medicina e Sociedade no tempo
da I República (Lisboa: Imprensa Nacional Casa da Moeda, 2010), p. 135.
 Diário do Governo: 13 de Maio de 1911, nº111, Série I,
Imprensa Nacional, [http://dre.pt/pdfgratis/1911/05/11100.pdf].
 Aires Gameiro, Augusto
Moutinho Borges, Ana Mateus Cardoso, Fernando D’Oliveira,“Um
Republicano no Convento”, Cadernos do CEIS20 [Centro de Estudos Interdisciplinares do Século XX], 2009, 13,
on pp. 27– 28.
 Barahona Fernandes, A
Psiquiatria em Portugal (Lisboa: Roche, 1984), p. 166.
 Gameiro et al., “Um
Republicano no Convento”.
 Aires Gameiro, “Evocação de um Médico Esquecido, o Dr. Luís
Cebola Pioneiro da Ocupação Ergoterápica na Casa de Saúde do Telhal, da Ordem
Hospitaleira de São João de Deus”, Medicina
na Beira Interior da Pré-história ao Século XXI, Marques, António Lourenço
(dir.), 2009, 23: 126–132.
 Thomas Söderqvist,
“A New Look at the genre of scientific biography” in The History and Poetics of Scientific Biography (Ashgate: Aldershot
and Burlington, 2007), pp. 1–15.
 Mary Terall, “Biography as Cultural
History of Science”, Isis, 2006, 97: 306–313.
 Mary Jo Nye, “Scientific Biography:
History of Science by Another Means”, Isis, 2006, 97: 322–329.
 Thomas Söderqvist, “What is the Use
of Writing Lives of Recent Scientists?” in Thomas Söderqvist, Ronald E. Doel (eds.), The Historiography of Contemporary
Science, Technology and Medicine: Writing Recent Science (New York:
Routledge, 2006), pp. 99–127.
 Lisboa, AHMCUL [Arquivo Histórico
do Museu de Ciência da Universidade de Lisboa], Processo Individual de José
Luíz Rodrigues Cebola Júnior, s. d., Cx. 1541.
 A Escola
Médico-Cirúrgica de Lisboa em 1899 – 1900, Annuario, José
António Serrano (ed.), (Lisboa: Imprensa Nacional, 1900), p. 41; A Escola Médico-Cirúrgica de Lisboa em 1905–1906, Annuario, P.
A. Bettencourt Raposo (ed.) (Lisboa: Imprensa Nacional, 1907), p. 100.
 Maria Esperança Pina,
“As Faculdades de Medicina na I República” in Corpo: Estado, medicina e Sociedade no tempo da I República, (Lisboa:
Imprensa Nacional Casa da Moeda, 2010), pp. 78–79.
Cebola, Memórias de Este e do Outro Mundo (Lisboa: Edição do autor, Lisboa, 1957), pp. 32–33.
 Fernandes, A
Psiquiatria em Portugal, p. 261.
 Luís Cebola, A
Mentalidade dos Epilépticos, (Setúbal: Edição do autor, 1906), foreword.
 Gameiro et al., “Um Republicano no Convento”, p. 14.
 Cebola, Memórias de Este e do Outro Mundo,
 Aires Gameiro (dir.), Casa de Saúde do Telhal 1º
Centenário 1893–1993 — Documentos Históricos e Clínicos, (Lisboa: Editorial
Hospitalidade, 1993), p.27.
 Joaquim Chorão Lavajo, Ordem Hospitaleira De S. João de
Deus em Portugal 1892–2002, (Lisboa: Editorial Hospitalidade, 2003), p. 70.
 Hospitalidade, Crónica Trimestral dos Irmãos de São João
de Deus em Portugal, vol. 1, (Sintra: Editorial Hospitalidade, 1936), p.
 Ilustração Portugueza –Carlos Malheiro Dias (dir.), Edição
semanal do jornal “O Século”, Lisboa, 24 de Outubro de 1910, 244, p. 522.
 Ramos, A Segunda
Fundação (1890–1926), p. 407.
 Lavajo, Ordem Hospitaleira De S. João de Deus em
Portugal 1892–2002, p. 92.
 Fernandes, A
Psiquiatria em Portugal, pp. 255–256.
 Pedro Teixeira Pereira, Eva Gomes, Olga Martins, “A
Alienação no Porto: O Hospital de Alienados do Conde de Ferreira (1883–1908)”, Revista da Faculdade de Letras – HISTÓRIA,
2005, III série, 6: 99–128, on p. 100.
 Lavajo, Ordem Hospitaleira, p.113.
 Meira de Carvalho, (1943), “Tratamentos no Telhal pelos
anos 30”, in Aires
Gameiro (dir.), Casa de Saúde do Telhal 1º Centenário 1893–1993 — Documentos
Históricos e Clínicos (Lisboa, Editorial Hospitalidade, 1993), p. 226.
 Meira de Carvalho, “Memória
Histórica sobre a Escola de Enfermagem” (1968), in Aires Gameiro (dir.), Casa de Saúde do Telhal 1º
Centenário 1893–1993 — Documentos Históricos e Clínicos (Lisboa, Editorial
Hospitalidade, 1993), p. 233.
Memórias de Este e do Outro Mundo, p.31; Luís
Cebola, “Evolução terapêutica na Casa de Saúde do Telhal” in Gameiro (dir.), Casa
de Saúde do Telhal, p. 222.
 Hospitalidade, Crónica Trimestral dos Irmãos de São João
de Deus em Portugal, vol. 9, (Sintra:
Editorial Hospitalidade, 1938), p. 32.
 Fr. Martinho Barroco Guiomar, “Arquivando para a História”
in Fr. Martinho B. Guiomar (dir.), Boletim
de Informação Familiar e Hospitalar, Vol. 9, 1952, pp. 119–120.
 Irmão Cândido, “Dados
biográficos” in Hospitalidade, Crónica Trimestral dos Irmãos de São
João de Deus em Portugal, vol. 223 (Sintra: Editorial
Hospitalidade, 1993), p.7.
 Carvalho, “Memória Histórica
sobre a Escola de Enfermagem”, p. 233.
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