Machado de Assis (1839–1908) is a well-known Brazilian writer, grandson of a freed slave, among whose vast literary opus is a satirical novella The Alienist, published in 1882. The central character of the novella is a physician Dr Becamarte, a consummate scientist, who married a woman based on her physical and anatomical characteristics such as a strong pulse, excellent eyesight and regular sleep patterns.
He soon realised that the care of the soul is the ‘worthiest concern for a doctor’ and turned his attention to the care of mad persons in the town. He was an avid student of Islamic medical texts and based his approach to treatment and diagnosis on those texts. Citing one such text that mad persons were saintly because God took their wits so that they would not sin, which he attributed it to a pontiff, Becamarte convinced the town council to build an asylum for the town's mad persons.
The asylum was soon built, and the doctor began what he considered his primary work, which was to study madness, classifying its diverse manifestations and finding a purely scientific explanation of its basic cause at a human level. He classified inmates into two main categories – violent or non-violent – and then further classified them based on various delusions and hallucinations. Originally he thought that madness was a small island in the ocean of sanity, but he came to see it more as an entire continent and not an island. Everyone was mad: gamblers, gossipers, people who exaggerated or prevaricated did not escape the doctor's emissaries. Soon, the majority of the town's inhabitants were in the asylum – including, at one point, the doctor's wife.
Townspeople soon realised what was happening and started ‘a pork chop revolution’ and took over the town council. The leader of the revolt, the town barber, went to see the doctor. A contretemps ensued when the leader of the revolt said to the doctor that most of his patients were sane; but that, he added, was a scientific issue and could not be resolved by politics.
Becamarte thereafter had an epiphany and came to believe that that disequilibrium of the mental faculties is normal and perfect equilibrium abnormal. The asylum was now admitting different groups of patients: those who were modest, truthful and sincere. A modest poet was cured when Becamarte made the town crier announce in the streets that the poet's work rivalled the greatest compositions of all times.
The doctor then released all the inmates and entered the asylum himself. He died there seven months later.
In this parable, Becamarte serves as a metonym for psychiatry: devoted to scientific understanding of the cause of madness and finding a cure for it, enduring its fair share of revolts; but then motivated by hubris focused less on caring for the truly mad in our society than on all the aspects of human behaviour, and in the process blurring the distinction between madness and normality.
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