FROM CASA VERDE TO PSYCHIATRIC REFORM: REPRESENTATIONS OF MADNESS IN THE ALIENIST AND THE HISTORICAL TRANSFORMATIONS OF BRAZILIAN PSYCHIATRY

Abstract

INTRODUCTION. The history of mental health care in Brazil has moved from predominantly exclusionary practices toward more humanized forms of care. In this context, The Alienist, by Machado de Assis, questions the boundaries between normality and madness and the power of medical knowledge over society. This study is justified by the importance of integrating literature and the history of psychiatry to understand social conceptions of madness. Analysis of the work enables critical reflection on the relationships among science, power, and exclusion, highlighting the need for care practices grounded in autonomy, citizenship, and human rights. OBJECTIVES. To analyze the representation of madness in The Alienist, relating it to the history of Brazilian psychiatry, the Psychiatric Reform movement, and social stigma. MATERIALS AND METHODS. This descriptive and qualitative narrative literature review was conducted in August 2026. Searches were performed in PubMed, SciELO, LILACS, and the CAPES Journals Portal. Publications from 2015 to August 2026, in Portuguese or English, available in full text and related to the topic were prioritized; earlier historical references were included when relevant for contextualization. RESULTS AND DISCUSSION. The analysis highlights the influence of medical authority and institutions on the social definition of normality and madness. Casa Verde is portrayed as a space of classification and confinement, critically echoing the asylum-based model historically predominant in Brazilian psychiatry, marked by segregation and restricted autonomy. In contrast, the Brazilian Psychiatric Reform promoted a community-based psychosocial care model guided by human rights. However, persistent stigma shows that overcoming exclusion requires changes in both healthcare services and social perceptions of psychological distress. FINAL CONSIDERATIONS. The relationship between literature and the history of psychiatry helps explain the transition from asylum-based care to community-based practices centered on freedom, humanization, autonomy, and social inclusion. The literary work therefore contributes to debates on mental health and human rights and encourages critical healthcare education committed to overcoming stigma.