When medicine and psychology enter school

Image: Anna Shvets


The explosion of medical and psychological diagnoses in schools does not seem to represent any kind of advance in the emancipatory perspective


The other day, I was talking to a friend about the current explosion of psychiatric and psychological diagnoses and how this phenomenon has influenced and interfered in the dynamics of school life. In the eyes of my interlocutor, the entry into the diagnosis scene seemed like a step forward. He remembered his school days, his classmates who were not “very normal” and who could benefit from the “advances” in the health sector.

A good reminder that we could bring to my friend is that medicine and psychology did not only begin to participate in school life recently. In reality, this relationship is a little older and dates mainly from the turn of the 19th century to the 20th century. During this period, there was a great naturalist temptation to call any process that did not follow a certain direction within the order a disease, any transformation that did not appear as organic and linear. All those who were not “well born” could then be classified as sick.

For example, the great mass movements that haunted the world of the propertied classes, whether the Haitian Revolution or the uprisings of the working class on European soil, were called a disease. A famous French psychologist, Gustave Le Bon, wrote about the insane predispositions of organized collective struggles. Another Frenchman, Alfred Binet, invented tests to measure intelligence and be able to separate the “naturally gifted” from those who could not have a “career open to talent”.

The historical ground on which the well-known Italian psychiatrist, Cesare Lombroso, appears is unlike any other, seeking to “scientifically” establish the stigmas that predispose people to crime. In Turin, a city in the industrialized north of Italy, he saw the inhabitants of the poor and agrarian South as inferior people, endowed with more “barbaric” characteristics. He coined the concept of atavism to point out a good dose of “animality” that existed in these “congenital criminals” and that could surface at any time.

On the other side of the world, North American psychologists turned the century in search of expanding the scope of Alfred Binet's research and experiments. It was mainly in this society that the instruments of “psychometry” flourished abundantly, psychological tests to quantitatively measure certain characters, aptitudes and behaviors. At a time when central countries were solidifying their national education systems, the influence of psychology, criminology, psychiatry and other branches of medicine on the direction of thought and pedagogical practice grew.


Such elements arrive in a country like Brazil as true panaceas that would make up for the gap in relation to more developed countries and would also help in the regeneration and moral constitution of its people. The idea of ​​“degeneration” also comes from psychiatry, a term widely used to characterize the racial traits that would be responsible for the incivility of the Brazilian people. Theories generated at the height of scientific racism arrived in Brazilian lands with the aim of solving our multiple problems, including our great pedagogical “dilemma”.

Brazil, at the same turn from the 19th to the 20th century, suffered from enormous rates of illiteracy. It was a doctor, Miguel Couto, who called this situation a true “disease” of the Brazilian people. The first public health doctors, building on Euclides da Cunha's observations, denounced the ills of the Brazilian backlands. Monteiro Lobato, another important writer of the time, had already created his figure of Jeca Tatu.

If, before learning about the work of public health doctors, he already thought that Jeca's problem was the lack of his own land, at one point he says that he was actually suffering from roundworms. From the writings of Monteiro Lobato, the alliance between Jeca Tatu and Biotônico Fontoura, a medicine designed to treat the character's ailments, will emerge. More than 30 million copies of the book that proposes such a correlation were produced, writings which were absorbed by countless families interested in the good development of their children.

It is interesting to observe this gap between the intention of importing what is most “scientific” in European production and the harsh Brazilian reality, arising from a long colonial and slave past. If the country had alarming levels of illiteracy, if its people were so poorly constituted, Medicine and Psychology would provide the real remedies. Not surprisingly, the first Ministry of Education, in the government of Getúlio Vargas, was also the Ministry of Health. Health and education came together in the first steps of the formation of the bourgeois State in Brazil. There was no talk of agrarian reform, no discussion of the true roots of Brazilian “backwardness”, no attempt to deeply understand the national teaching structure, but all hopes of national regeneration were thrown into so-called neutral science.

After the days of the most outrageous scientific racism with the victory over the Nazi-fascist beast, the relationship between health and schooling took a new direction. Psychology continued to be postulated as the ultimate guide for pedagogical practice by the main names of the “New School”, a broad process of renewal of Brazilian Education. This psychology, however, was no longer the same as in the previous period. Environmental reasons came into play, the so-called “cultural deficiencies”, “unconscious furniture”, but what has remained and will be the constant emphasis to this day is the idea that health comes to remedy what is faulty in education.


With the production of the Diagnostic and Statistical Manual of Mental Disorders (DSM), this idea crystallized with greater force. From its first version to the most recent version (DSM 5), more than 300 new diagnoses have already been included. The ones that most reached schools were diagnoses of dyslexia and, more recently, attention deficit hyperactivity disorder (ADHD). Hardly anyone goes through school today without at least hearing about this psychiatric entity. More than just hearing about it, many children are diagnosed with ADHD and use the medication Ritalin, the commercial name for methylphenidate, whose sales reach alarming figures in Brazil.

If in private schools and among those with better material conditions the diagnosis can serve more individualizing pedagogical practices, we cannot say that the experience in public schools is the same. Observing this difference sheds light on the very dynamics and structure of the phenomenon of medicalization of education, that is, the transposition of educational problems to the grammar of medicine and health, transforming problems embedded in the social totality into medical issues.

Medicalization is not limited to the greater sale of medicines or even the greater supply of medical and psychological services. Medicalization operates with the creation of a certain field of “normality” that starts to direct political actions, more specifically health actions.

In the world of capital, in which there is a brutal social and racial division of labor, the school can be and has been, in most contexts, a vehicle for reproducing the ideology of bourgeois society. In peripheral countries, where part of the population will not even have access to formal employment, part of this school function has always been out of place in relation to European models.

Studying Brazilian history, we see how the need to control these “excluded” segments largely involved the imposition of fields of normality produced by medicine and psychology, which, when entering the legal-political field, serve as a weapon of domination and repression by the bourgeoisie over the working class and the poor population.

Searching for the elements that predispose to crime and that meet the “natural” path of domination has always been one of the main functions of the medicalization of education in Brazil. In addition to giving substance to the measures of the repressive apparatus, medicalization also falsifies the real materiality of the so-called “Brazilian backwardness”. Instead of looking for the furniture of the educational situation in the structure of Brazilian class society by observing the real situation of Brazilian schools, medicalization makes it appear that it is just a health problem, which is much more an economic-political problem, which can only be resolved by the transformation of the social totality through the mediations of political power.


Returning to the questions that began our text, we could now, more forcefully, say that the current explosion of medical and psychological diagnoses in schools does not seem to represent any kind of advance in the emancipatory perspective. Mainly in public schools, diagnoses have served as producers of stigma and weapons of exclusion. The person diagnosed is part of a kind of self-fulfilling prophecy, in which the medical diagnosis serves to justify the educational failure planned by the Brazilian ruling classes.

More than producing health diagnoses, which can be useful in specific clinical situations, true emancipatory forces must be concerned with the specificities of the school. What makes a good school are good psychologists and good doctors? Wouldn't this explanation be precisely the burial of the school's specificity? If we are based on Brazilian history, at the very least we should doubt this alliance that once united eugenicists and hygienists and many of those considered patrons of Brazilian education.

*Romulo Caires He is a family health doctor and is studying for a master's degree in Education at UFBA.

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