Mad in Portugal

Estado Novo, the authoritarian regime that ruled Portugal for decades, was overthrown back in 1974, but its legacy still holds sway over the country’s psychiatric system. As Tiago Pires Marques, one of the founders of Mad in Portugal, describes it, “There’s a strange singularity about psychiatry in Portugal.” Along with blocking the development of psychotherapy in Portugal, allowing biomedicine to reign supreme, the regime’s leaders left the country with a sharp power imbalance between the field of medicine and the general public, making it difficult for alternative approaches to gain momentum.

After Estado Novo’s toppling, Portuguese psychiatrists initially divided into two camps—but in the end, both wound up with a biomedical outlook on distress. One group took a left-wing approach, limiting their efforts to improving existing psychiatric hospitals while viewing alternative solutions as attempts to privatize the mental health sector. Meanwhile, the other group advocated for community mental health, a movement later corrupted by the overarching global mental health movement and its biomedical leanings, which left most of Portugal’s community mental health centers focused solely on distributing medication.

“Generally, there’s a lot of resistance to anything outside of the biomedical model,” says Celina Vilas-Boas, another Mad in Portugal co-founder, of Portugal today. Even so, Vilas-Boas and the others at Mad in Portugal have noticed a growing desire for change, particularly while working directly with people who had experience in the psychiatric system.

“These people voiced a concern over the lack of alternatives,” explains Pires Marques, “[about] the fact that they were not heard, that their voices were silenced, were discredited.” For Pires Marques, a historian of the social sciences, this observation came from academic collaborations with people who had received psychiatric diagnoses, which opened his eyes to the harmful use of psychiatric medications—something Portugal consumes at particularly high rate. From here, Pires Marques shifted beyond academia, creating a group called JustaMente!—meaning fair or just mind in Portuguese—which collaborated on various creative and research texts.

Pires Marques also learned more about the psychiatric system’s faults from forging connections with survivor’s movements in other countries, particularly Brazil, where psychiatric reform is more developed than in Portugal. In addition, he was inspired by Mad in America founder Robert Whitaker’s books and the impact he saw Mad in America having in the United States. “It was easy to see that the website had a strong impact, that it could stir things up,” he says. “I got more and more enthusiastic about the idea of contributing to construct something in Portugal, because in Portugal there’s really a void in alternatives to psychiatry.”

Pires Marques found his opportunity to do this after connecting with Vilas-Boas through Portugal’s Hearing Voices Movement. Vilas-Boas, a trained psychologist herself, first became skeptical of psychiatry’s conventions while volunteering in a psychiatric hospital alongside the completion of her degree. “There was always this distance between what I was seeing in the psychiatric hospital and what I was learning,” she says—and she questioned whether these hospitals were truly the best response to the problems they intended to solve. After this, Vilas-Boas became involved in various social movements related to mental health, even helping to launch the Hearing Voices Movement in Portugal, and the knowledge she gained from this only solidified her existing feelings about psychiatry.

To found Mad in Portugal, Pires Marques and Vilas-Boas joined forces with Mattia Faustini, a researcher interested in using art and literature to collaborate with psychiatric survivors, particularly through writing and reading workshops. The three hoped that their platform could connect those whose views on mental distress diverged from the mainstream narrative—people who otherwise tended to be “isolated in their own services and institutions,” as Vilas Boas describes it. The goal, as stated on their website, is to foster critical thinking while welcoming “a plurality of perspectives” on distress.

On the site, Mad in Portugal’s readers can find blog articles, book reviews, and first-person testimonials from voices less present in mainstream narratives around mental distress. As Pires Marques describes it, the work Mad in Portugal publishes “reflects our understanding of the Portuguese context, the public to which we are talking, and also our sensibilities.”

For example, because Pires Marques has a background in history and the social sciences, the team is committed to incorporating ideas from these disciplines in the work they publish. “I think the social sciences have a very important role to play in the field of mental health,” Pires Marques explains. “[The field] has been underrepresented even in many progressive, emancipatory, and critical approaches to mental health.” Similarly, Faustini’s propensity for literature is evident from the site’s Arts corner, which primarily publishes poetry.

Translations of material from other Mad in the World affiliate sites and various places around the Internet are also prominent on Mad in Portugal’s website. “One thing people with experience point out is that people that have access to English are able to access all these groups and all this information,” says Vilas-Boas. This leaves many people in Portugal unable to access resources about topics like tapering from psychiatric medications or accessing alternative modes of treatment—and providing translated content relevant to a Portuguese audience is Mad in Portugal’s way of addressing this gap.

Along with providing work to translate, the broader Mad in the World network has been valuable for Mad in Portugal by helping to attract readers to the site, since this affiliation gives weight to the work the site is doing. In addition, Mad in Portugal’s team notes that readers tend to discover the website through international movements or websites that are easier to come across, making Mad in Portugal’s link to an international network essential.

Overall, the team is pleased with the site’s readership, particularly in proportion to the Portuguese population that’s actually interested in alternatives to psychiatry—though Vilas-Boas does note that they don’t receive many comments or other more active forms of engagement. “I think we were all very surprised by the amount of traffic on the website when we first received the statistics,” she says. “It’s very passive reading. But that’s very on-character in Portugal.”

Moving forward, the team hopes to produce more original content, which can be a challenge at times since everyone on the team leads a busy life. In particular, they’d like to highlight topics specific to a Portuguese context, such as connections between mental health issues and Portugal’s pioneering drug decriminalization policies. They also aim to feature more work created by people with experience in the psychiatric system, a group they’ve found difficult to attract because a lack of relevant activist groups in Portugal leaves service users and survivors dispersed from one another.

In addition, the team plans to increase their focus on collaboration. While they spent their first year as a team learning to work together and determining a pace that fit everyone’s needs, they’re now excited to grow their network, beginning with a small event where the group will meet with others whose projects align with their mission. “Digital media has a great potential,” Pires Marques says of this, “but we’ve also observed that some people really want an in-person way of relating, so we’re trying to create the conditions for that to happen.” Through this, the group hopes to build connections and make Mad in Portugal a forum to spread the word about relevant projects.

They’ve also received contact from a number of younger psychology students seeking to collaborate, which they take as a positive sign of change. “I think the younger generations of professionals tend to be more responsive to a site like Mad in Portugal,” says Pires Marques—and hopefully, this trend will only increase as time goes on.

Still, the group intends to be cautious in expanding their network. Currently, Vilas-Boas explains, Mad in Portugal benefits from being small, since this allows its members to know each other “as people” and maintain consistent contact. “It’s okay not to be too big,” adds Pires Marques. “We want [Mad in Portugal] to be manageable and then grow very steadily and organically.”