Nineteenth-century Brazilian doctors did not agree on the causes of insanity any more than they agreed on what insanity actually was. As a group, they believed that it grew from multiple roots. Some hypothesized physical causes, as yet unseen or unidentified by medical science, while others saw nonphysical triggers in play such as luxury, poverty, bad luck, or religious excitement. Civilization itself was also often cited as the underlying cause of many kinds of insanity, with some thinkers positing that the demands of urbanization detrimentally affected weak or fragile personalities, unable as they were to keep their feet within the polyglot whirlwind of an internationally emergent Atlantic metropolis like Rio. Despite the divergent views of the originating causes of insanity, a growing consensus stipulated that it was on the rise throughout the opening decades of the nineteenth century. Even if doctors could not agree on what exactly insanity was, or what caused it, they agreed that the treatments employed in the premier public institution in the city, the Santa Casa de Misericordia Hospital, were arcane and grossly inadequate.

Medical and state officials around the Atlantic world grew concerned that the mad haunted the cities for which they had such new and carefully designed plans. This concern, along with advances in medicine and the secularization of insanity, led to the proliferation of asylums in a number of countries and with it, the rise of psychiatry as a profession. In this, Brazil was no exception. This chapter chronicles the asylum-building campaign in mid-nineteenth-century Rio de Janeiro, with a focus on how the campaign was launched by medical doctors, some of whom would, with the forming of a discrete space for the treatment of mental illness, become Brazil's first psychiatrists. Although their call to construct an asylum was based on local political and medical circumstances, they drew their intellectual impetus from the Atlantic marketplace of ideas. Political and intellectual currents in France, in particular, electrified Brazilian medical doctors intent on transforming the management of madness. More specifically, the context from which French psychiatrist, Philippe Pinel (1745–1826) articulated a more humane medical treatment of the mentally ill, known as “the moral treatment,” grounded an aspirational narrative with which reformers advocated for the construction of Brazil's first asylum.