Brazil has something that does not exist in this form in Europe: a network of around 50 psychiatric hospitals that, for more than half a century, have combined conventional psychiatry — ICD/DSM diagnostics, psychotropic medication, medical rounds — with spiritist practices such as disobsession (spirit release) and the passe (laying on of hands). The most important scientific account is the review by Giancarlo Lucchetti, Alexander Moreira-Almeida and colleagues (2012), who studied six leading hospitals. Their conclusion is two-faced: the model is strikingly durable and accepted by patients — and at the same time barely supported by hard evidence.
A treatment model with two pillars
The Brazilian model is not alternative medicine that replaces conventional care. It is explicitly integrative: the spiritist hospitals are regular, state-recognised psychiatric clinics with licensed physicians, nursing staff and full conventional treatment. On top of that sits a second, expressly voluntary offering of spiritual therapy. Lucchetti et al. summarise the typical components:
- Fluidotherapy / passe: laying on of hands, understood as transmitting "healing fluids" (close in self-understanding to Reiki, but grounded in Kardecist doctrine)
- Lectures on spiritual and ethical topics — moral orientation, not compulsion of belief
- Intercessory prayer for the patients
- Disobsession (spirit release therapy): treatment of what is, in spiritist terms, interpreted as the disturbing influence of departed spirits
- Fraternal dialogue (diálogo fraterno): a pastoral, attentive one-to-one conversation
Crucial, according to Lucchetti et al., is non-indoctrination: no one has to become a Spiritist or believe the spirit hypothesis to be admitted. It is precisely this optional nature, the authors argue, that appears to increase acceptance among patients and families — including Catholics, Protestants and the non-religious.
The theoretical root: obsession and disobsession
The spiritual concept behind these clinics is more than a century old. At its core it goes back to Bezerra de Menezes, the "doctor of the poor", who in his 1897 work A Loucura sob Novo Prisma ("Madness under a New Prism") interpreted part of mental illness as obsession — influence by unreleased spirits. Disobsession is the therapeutic answer. Important for historical context: Bezerra himself saw the tension with the emerging modern psychiatry and argued for medical treatment; the concept was never meant as a replacement, but as a complement. Today's integrative practice is the institutionalised form of that basic idea.
Organisationally the whole is carried by the network of the Brazilian Spiritist Federation and the doctrine of Allan Kardec, in which illness, reincarnation and moral development are thought together. The spiritist principle that spiritual services must be free of charge also shapes the charitable character of these hospitals.
History: from the Sanatório Espírita de Uberaba to a nationwide network
The combination of institutional psychiatry and Spiritism in Brazil reaches back to the 1930s. One of the oldest and best-known houses is the Sanatório Espírita de Uberaba (Minas Gerais): emerging from an initiative of spiritist circles around the mediums Eurípedes Barsanulfo and Maria Modesto Cravo, construction began in 1927 and the asylum opened in 1933. It still exists today — as the Instituto Maria Modesto Cravo. Other formative houses are the Hospital Espírita André Luiz in Belo Horizonte and clinics in Porto Alegre, São Paulo, Marília and other cities.
That this model arose and survived in Brazil is no accident: it coincides with the enormous spread of Spiritism in Brazil and a historically chronically under-resourced public psychiatry, in which faith-based institutions filled a real gap in care.
The Lucchetti study (2012): the model described — and its gap named
The paper "Spiritist Psychiatric Hospitals in Brazil: Integration of Conventional Psychiatric Treatment and Spiritual Complementary Therapy" appeared in 2012 in Culture, Medicine and Psychiatry. It remains the authoritative overview. The researchers — among them Alexander Moreira-Almeida, one of the internationally most respected researchers on spirituality and mental health (he also appears in our SPECT study on psychography) — analysed six leading spiritist psychiatric hospitals and their treatment practice.
Two core statements shape the study:
1. The model works organisationally and is accepted. For more than fifty years these houses have maintained integrative care; the voluntary, non-missionary nature of the spiritual offerings increases their uptake.
2. The scientific evidence is missing. The authors put this unusually plainly: the lack of standardised treatment protocols and controlled studies remains a barrier to assessing the actual effect of this integrative approach on mental health, quality of life, treatment adherence and perceived quality of care.
"The lack of standardised treatment protocols and scientific studies remains a barrier to assessing the impact of this integrative approach on patients' mental health." — Lucchetti et al., Culture, Medicine and Psychiatry 2012
What hard data exist
Beyond the purely descriptive, some research has been done — mostly outside the inpatient hospitals, in spiritist centres, but methodologically relevant:
- Passe and anxiety (Cavalcante et al., 2016): the methodologically cleanest work. A randomised, sham-controlled design (real vs. "sham" passe) with 50 analysed participants over eight weekly sessions. Result: anxiety scores (STAI) fell in both groups, but more strongly in the passe group; at the end only 17% of the intervention versus 63% of the control group still met the anxiety criterion. The authors' conclusion: promising, but a small pilot — larger trials needed.
- Spiritual treatment for depression (Lucchetti et al., 2015): a descriptive study of a 90-minute "spiritual healing session" in São Paulo (lecture + disobsession + passe + counselling) with measurable reductions in negative affect and muscle tension and an increase in wellbeing — but a very small sample.
- Spiritist involvement and mental health: cross-sectional findings link higher spiritist involvement with lower rates of stress, anxiety, depression and suicidal ideation — though correlation here expressly does not prove causation.
How this should be assessed
Three readings suggest themselves, and an honest treatment keeps them open:
- Non-specific factors: attention, ritual, community, meaning-making, expectation (placebo) — well-documented, "natural" mechanisms that any form of ritualised care can mobilise.
- Structural advantage: a treatment frame that takes patients' religious language seriously instead of pathologising it can increase trust and adherence — regardless of whether the spirit hypothesis is true.
- Specific effect of the practices: the strongest but least supported claim. Apart from the small Cavalcante RCT, cleanly controlled evidence is lacking.
Keeping the levels apart matters: that patients in these houses appear to be well cared for and feel accepted is plausible and partly documented. That the specifically spiritist practices work beyond non-specific factors — and even more, that the underlying spirit hypothesis is true — is not thereby shown. It is precisely this discrimination that also marks psychography research and cases such as Zé Arigó: measurable phenomena on one side, worldview interpretation on the other.
Why it matters for Europe too
Independent of the spirit question, the Brazilian model touches a debate that has long arrived in Western psychiatry: the question of spiritual history-taking and culturally sensitive care. The WHO and psychiatric associations increasingly recognise that religiosity and spirituality are a coping resource for many patients. Brazil has — with all open questions — tested in practice over decades how a psychiatric institution can integrate the spiritual language of its patients without abandoning conventional medicine. That a single medium even worked inside a Swiss psychiatric hospital shows the question is not confined to Brazil.
Conclusion
Brazil's spiritist psychiatric hospitals are a remarkable care model grown over more than half a century — carefully described in the study by Lucchetti et al. (2012), but only beginning to be scientifically examined. Anyone expecting proof of efficacy of spiritist healing will be disappointed; anyone looking for an example of integrative, culturally sensitive and expressly non-indoctrinating psychiatry will find a rich, still under-researched field here. The most honest sentence about this model comes from the researchers themselves: the most interesting question — whether it works beyond the care it provides — has simply not yet been answered.
Sources
- Lucchetti G, Aguiar PRDC, Braghetta CC, Vallada CP, Moreira-Almeida A, Vallada H. Spiritist Psychiatric Hospitals in Brazil: Integration of Conventional Psychiatric Treatment and Spiritual Complementary Therapy. Culture, Medicine and Psychiatry. 2012;36(1):124–135.
- Cavalcante AGM et al. Effect of the Spiritist "passe" energy therapy in reducing anxiety in volunteers: A randomized controlled trial. Complementary Therapies in Medicine. 2016;27:18–24.
- Lucchetti G et al. Spiritual Treatment for Depression in Brazil: An Experience from Spiritism. EXPLORE (The Journal of Science and Healing). 2015;11(5):377–386.
- Moreira-Almeida A. Spiritist Views of Mental Disorders in Brazil. Transcultural Psychiatry. 2007.
- Bezerra de Menezes A. A Loucura sob Novo Prisma. 1897.
- Background: Bezerra de Menezes and disobsession; Mediumship in Brazil; the SPECT study on psychography.