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Sexuality and Disability, Vol. 20, No.

1, Spring 2002 ( 2002)

Sexuality, Parenthood, and Cognitive Disability


in Brazil
Pamela Block, Ph.D.1,2

This article will review the different methods used to control the sexuality and
fertility of Brazilian women with cognitive disabilities throughout the twentieth
century, and how practices such as eugenic sterilization, institutionalization,
and other repressive measures of social control grew out of cultural notions of
gender, race, class, sexuality, and disability. The article will first outline eugenics practices and the vulnerability of women with cognitive disabilities in
the United States and Europe. It will then trace the historical treatment of
Brazilian women with cognitive disabilities. Finally, it will describe modern
cultural perceptions and practices related to the sexuality and fertility of Brazilian women with cognitive disabilities.
KEY WORDS: sexuality; parenthood; intellectual disability; sterilization; eugenics.

INTRODUCTION
For much of the twentieth century, individuals stigmatized by gender, race,
poverty, disability or sexuality were subject to extreme methods of social control in the United States and Europe. Women with cognitive disabilities3 were
considered especially dangerous as it was thought that feeblemindedness
could be transmitted from generation to generation. Thus, a great deal of effort
was expended to prevent women identified as cognitively disabled from having
children. Practices perpetrated on these women included compulsory institu1

Center for Alcohol and Addiction Studies, Brown University.


Address correspondence to: Pamela Block, Ph.D., Center for Alcohol and Addiction Studies,
Brown University, Box G-BH, Providence, RI 02906; e-mail: Pamela Blockbrown.edu.
3
I choose to use the term cognitive disability rather than the diagnostic term mental retardation
or the Portuguese deficiencia mental because it is less pejorative, and yet still meaningful in both
Portuguese and English.
7
2

0146-1044/02/0300-0007/0 2002 Human Sciences Press, Inc.

Block

tionalization and sterilization, as policy makers focused on ways to reduce perceived threats to the social order. However, theories and approaches to social
marginality differed from place to place as professional theories were influenced by cultural beliefs in particular social contexts. In Brazil, sterilization and
institutionalization were practiced upon women, but were never mandated by
the state. In the absence of official policy, cultural beliefs and professional
opinions shaped the practices used by professionals and family members to
regulate the sexuality of women with cognitive disabilities. This article will
review the different methods used to control the sexuality and fertility of Brazilian women with cognitive disabilities throughout the twentieth century and
how such practices as eugenic sterilization, institutionalization, and other repressive measures of social control grew out of cultural notions of gender, race,
class, sexuality, and disability.
In 19951996 I conducted ethnographic and archival research in Brazil on
the topic of cultural perceptions and professional theories of cognitive disability
with a focus on sexuality and fertility control. I collected historical documents,
interviewed dozens of professionals, parents, and people with disabilities, and
conducted participant observation at several vocational and residential programs
in two of Brazils largest cities. Brazil is perceived as underdeveloped (one
author even used the term retarded) in the realm of economics, politics, and
in the social service systems (1). During the course of my research, Brazilian
human service professionals expressed to me that Brazil is 20 years behind the
United States. This implies that Brazils service system developed through the
same evolutionary progression as the system in the United States. It also implies that practices in the United States are, and have always been, more progressive than practices in Brazil. Both of these assertions are false. Actually,
Brazils system developed quite differently than the system in the United States
and was, in many ways, more progressive and humane. The root of this
difference lies in differing cultural definitions of cognitive disability, gender
and sexuality, and also differences in the eugenics movements of the two countries.

EUGENICS AND COGNITIVE DISABILITY


In the United States, the eugenics movement was crucial to the evolution
of services for people diagnosed with cognitive disability. Eugenics, the science
of the genetic improvement of the human race, was influenced by Darwins
theory of the importance of heredity in the evolutionary process, and Mendels
research on the transmission of genetic traits over generations. Meaning to harness the force of heredity for the improvement of man (2), eugenics was used
to establish race and class distinctions as natural and incontrovertible (3). The

Sexuality, Parenthood, and Cognitive Disability in Brazil

upper class dominated because of their superior genetic heritage; the poor remained in poverty because of their degenerate genes.
Unlike in the United States, there is no cultural legacy affirming and legitimizing the sterilization of people with cognitive disabilities in Brazil. Sterilizations conducted for convenience or for eugenics did take place, but were comparatively rare. In the United States tens of thousands of individuals with this
diagnosis were sterilized during the first half of the twentieth century (4). Because of historical differences, such as the influence of Lamarckism on the
Brazilian eugenics movement, religious, and humanist influences, the Brazilian
eugenics movement did not unite to lobby for the large-scale segregation of
people with cognitive disabilities.
Early diagnoses of cognitive disability, usually based on observation,
often coincided with regional, class, and racial designations. As in the United
States, the eugenics movement in Brazil was sparked by professional concern
over social problems, such as rapid urbanization, caused by the emancipation of
the slaves and immigration (5). The movement included a continuum of eugenics theories, both Lamarckian and Mendelian. In Lamarckian-influenced eugenics, it was thought that genetic traits were influenced by environmental factors, such as improved sanitation, better hygiene, and access to better medical
care and clean water. Such beliefs led Brazilian eugenicists to adopt slogans
such as to sanitize is to eugenize and sanitation-eugenics is order and progress (5, pp. 119121). In 1918, Belisario Penna wrote about the health problems of rural Northeastern Brazilians:
In a country of sick and illiterate people like Brazil, the greatest primordial worry
of conscientious policy makers should be physical, moral and intellectual sanitation of
its inhabitants.
There is no prosperity, there can be no progress amongst ignorant individuals, and
much less so when ignorance joins with sickness, vice, physical and intellectual deficiency, and the destruction of essential organs.
Disgracefully, this is the case of Brazil, which easily counts 80% of its illiterates
and other such inhabitants affected by various avoidable illnesses. These individuals
vegetate in the cities, the countryside and the remote interior, consuming without producing, rendering the nation anemic, or at least hindering its impulse toward progress
and expansion. (6, p. 7)4

Thus the poverty-stricken people of the rural interior were viewed not as social
threats, but as pitiable and their problems avoidable through improvements in
public health and mental hygiene (6,7,b 8).
Nancy Stepan (1976) notes that perceptions of Brazil as a vast hospital
and pointed to perceptions of a great mental and medical chasm separating the
urban elites from the mass of people living in rural poverty (9). This gulf is
evident in Pennas descriptions of his interactions with the local population
during his travels:
4

This and all subsequent translations are my own.

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Centers of population [were] between 60 and 300 individuals, the majority of them
idiots, cretins, crippled or paralytic. We searched in order to find, with difficulty, a semiidiot, capable of giving some quick information. (6, p. 10)

This statement evidences a low opinion of the cognitive abilities of the people
encountered during Pennas research in rural communities. Yet, despite preconceptions based on race, class and regional differences, Penna and most other
professionals, especially those writing before 1920, were careful to stay away
from models of genetic inheritance based on race and class. This differs from
the United States, where rigid Mendelian models of the transmission of pathological genetic traits across generations, espoused by Henry H. Goddard (1913)
and others, were widely accepted by the end of the second decade of the twentieth century (10). At a time when institutional models of strict segregation
were being put into place in the United States, Brazilian professionals were
concerned with using science and technology to improve the lives of people on
the margins of society. Since better health was thought to lead to better genes, it
was not considered necessary to institutionalize people.
However, in 1920s some factions of the Brazilian eugenics and mental
hygiene movement examined the practice of sterilization and its potential uses
for social control and the prevention of racial degeneration. Individuals with
cognitive disabilities were included in lists of social threats alongside criminals,
degenerates, vagabonds, psychopaths, etc.
The right to perpetuate their suffering, deformity, and misery cannot be allowed to the
sick, degenerate, feeble, and gravely intoxicated. The present generation has the obligation to protect and defend future generations. To create pain is a crime against humanity;
to create monstrosity is a crime against the race. The marriage of those ill in spirit and
body, freaks, cacoplasts5 and defectivesthe producers of abortions and martyrsought
to be forbidden, or, at least, should not be sanctioned by law. (12)

Between the 1920s and 1940s there were three methods discussed by Brazilian
eugenicists to reduce these populations: prenuptial examinations to prevent the
unfit from marrying, segregation apart from society to prevent reproduction,
and eugenic sterilization.
Over the course of two decades, Dr. Renato Kehl, founder and editor of
the Boletim de Eugena (Eugenics Bulletin), published dozens of books and
articles in support of extreme (negative) eugenics policies, including eugenic
sterilization (Kehl, 1921, 1923, 1925, 1933, 1935, 1938, 1942). Kehl was explicit about his goals, citing American, German, and English sources on the
efficacy of sterilization:
In order to achieve thorough results sterilization would need to be applied compulsorily,
be of a permanent nature, and on a vast scale, and must not spare even the individuals
5

Goddard (1913) coined the term Kallikak to refer to a family he studied. The term comes from
the greek words kallos (beauty) and kakos (bad) (11). The term kakos was adopted internationally.
Cacoplast and cacogenic refer respectively to bad blood and bad genes.

Sexuality, Parenthood, and Cognitive Disability in Brazil

11

that appear superficially normal but are, nevertheless, intrinsically defective. Such cases
are not rareon the contrary. Every day individuals are examined that married under
these conditions, and, even when married to a normal person, had degenerate progeny.
(13, p. 156)

Kehls work linked nineteenth-century theories of racial degeneration to the


twentieth century Brazilian eugenics. He quoted Belisario Penna and Arthur
Nieva, highlighting supposed the lack of intelligence of people living in rural
areas (14, p. 19). In 1938 Kehl included the following advice for individuals of
good breeding:
Avoid marriage with a person of inferior class, and, above all, with individuals of a
different race and with first-generation mesticos. It is proven that such marriages are
dysgenic, giving origin to physically, psychically, and morally inferior types. (18, p. 65)

Most mental hygienists and eugenicists were less specific on the issue of race,
especially those based in Rio de Janeiro where one of the founders of the field,
Dr. Juliano Moreira, was himself a mestico from a good family in Bahia.
When discussing pathological inheritance, it was common for Brazilian
authors to cite Goddards (10) research on the Kallikaks, Dugdales (1910)
research on the Jukes and other eugenics theorists from the United States and
Europe (20). Thus potential for inheriting cognitive disability was also of concern to Brazilian professionals (15,21,22,23). During a June 1930 meeting of
the Brazilian League of Mental Hygiene (LBHM), gynecologist Juana de Lopes
cited the celebre Kallikak family during a discussion regarding dominant
and recessive pathological inheritance (24).
Paulo de Godoy Moreira e Costa (1927), discussed potential role of negative eugenics in the future of the Brazilian race: The future generation of
Brazil depends on it; the birth of a new, stronger, healthier, better looking nationality depends on it (23, p. 56). For Moreira e Costa, sterilization was a way
to construct a new and improved national and racial identity. His concern about
changing physical appearance clearly involved the motive of whitening the
Brazilian population (25). In addition, eugenic sterilization was constructed as a
means to modernize the country. He described Brazil as developmentally delayed on a national level: [a] confluence of all peoples, in a confused tangle of
migration, still being served by the bull cart of custom rather than the automobile of Eugenics (23, p. 56). Moreira e Costa, Kehl, and other advocates of
sterilization wrote that the practice was safer and more effective than other
forms of birth control, such as incomplete coitus, spermicides, sponges, condoms, and abortion. In the 1930s, the Brazilian government was sympathetic to
Germany and supportive of eugenic ideals. During this time, eugenics laws
were passed to mandate prenuptial examinations (7). Such laws were specifically designed to deny marriage to people with disabilities such as deafness or
mental deficiency (26).
Although a supporter of sterilization in some cases, Dr. Jefferson Lemos

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(1933) wrote that large-scale sterilization programs would lead to the destruction of not just degenerate stock, but also people of genius (27). To Lemos,
sterilization was acceptable when enacted in individual cases, but he felt legislation would limit the ability of practitioners to make decisions based on individual cases and the dictates of their conscience. He defended the rights of
individuals (if they were doctors) to make their own decisions regarding the
morality of the practice and its merits in certain cases.
Alberto Farani (1931) brushed aside such defense of the rights of individuals, stating, the possible hypothesis of good descendents does not outweigh
the probability of bad elements (21, original emphasis, p. 171). On the issue of
cognitive disability Farani stated:
The church does not allow sterilization, this is clear, but it considers blocking the marriage of feeble-minded individuals acceptable, for example. It is true that the churchs
pretext is not the quality of descendents, but the incapacity to make a valid contract. (21,
p. 174)

Farani recognized that some scholars advocate segregation in custodial facilities


as an appropriate means of controlling the reproduction of degenerates. Although others considered institutionalization to be a more humane approach to
the issue, Farani did not agree:
I will not discuss the cruelty of such procedure. I will only mention that which is
quite clear: it is impossible to institutionalize all flawed individuals. However, in the
present circumstances, the greatest threat is the possibility of multiplication through
inheritance. Sterilization and liberty are more rational, economical, and humane than
impeding reproduction through segregation until menopause . . . Now, it is proven that
this practice is not only cruel, but also very costly. (21, pp. 1756)

Farani believed that, if accepted as state policy, the religious prohibition on


interfering with the act of sexual procreation would lead to the degeneration of
the Brazilian population. He viewed sterilization as more humane than the segregation of degenerate populations. Farani included all degenerate populations in his critique, but concentrates specifically on the issue of segregating
versus sterilizing individuals with cognitive disabilities.
Although a strong advocate of sterilization, Renato Kehl also spoke favorably of the practice of segregation of people with cognitive disabilities (16). He
stated that the practice had been effective in the United States and England, and
praised Englands Mental Deficiency Act of 1913 because it oversees institutionalization or vigilance, the economic utilization of abnormals, and prevents
any sexual relations with abnormals (16, p. 185). Although Kehl believed the
proper execution of such laws could only be achieved in well organized countries he concluded that certain aspects might be applied to the Brazilian context:
Above all it would be desirable to have an obligatory exam and register all abnormal children attending school in order to remove them from the daily life of normal

Sexuality, Parenthood, and Cognitive Disability in Brazil

13

individuals, give them adequate instruction, and commit them to special asylum colonies
for the time necessary to reveal those that are dangerous or incompatible to a life of
complete liberty. (16, p. 185)

Kehl explicitly stated that only those who had been sterilized should be released
from asylums. He described people with cognitive disabilities and psychiatric
illnesses as human residues the cause of misery, the misfortune of so many
families (16, p. 190). However, he concluded that sterilization might allow
such people to live normal lives. For example, couples that were capable of
taking care of themselves but incapable of taking care of children would be
allowed to exist in childless harmony. Kehl summarized the indications that, to
his view, justified sterilization:
a) Sterilization of the insane and those with perverse instincts; b) sterilization of the
greatly criminal and miserable; c) economic sterilization, in the case of couples incapable of providing, by their own effort, the environment necessary to guarantee the subsistence and education of their children; d) social sterilization in order to reduce the
rising expense of when the social system is forced to sustain asylums for the increasing
numbers of feeble-minded and those unable to work; e) obligatory sterilization, imposed
upon the mentally ill; f) voluntary sterilization, practiced habitually by the tubercular, . . . and by women after repeated pregnancies, when their life is in danger and their
death would leave their children in an orphanage.
In synthesis, these are the principal indications for eugenic measures that, sooner or
later, will be adopted in Brazil as well. (16 original emphasis, p. 194)

Kehls list is reminiscent of the list developed by Harry Laughlin of the US


Eugenics Record Office that was subsequently incorporated into mandatory
sterilization laws across the United States (28).6 However Kehls list is even
more vague and expansive.
Beginning in the late 1930s and early 1940s, and especially after Brazil
joined the Allied Forces against Germany; theorists critical of the practice of
eugenic sterilization grew more numerous and more vocal. Supporters of the
practice became more hesitant to put their views in print. Rodolpho Vilhena
(1934) was critical of the eugenic sterilization of people with cognitive disabilities in Esterilizaca o dos Anormaes (29). Evandro Muniz Neto (1937) provided
a thorough review of the Brazilian and international literature concerning sterilization in his book Esterilizaca o e Direito Penal (30). Muniz Neto (1937)
claimed that many pathological inheritances of different ethnic groups could
be improved through better nutrition, citing Brazilian anthropologists, Gilberto
Freyre, Roquette-Pinto, Alberto Torres, and Oliveira Vianna to support his
claim. He stated that: Illnesses judged incurable during one hour are easy to
6

1) feeble-minded; 2) insane (including psychopathic); 3) criminalistic (including the delinquent and


wayward); 4) epileptic; 5) inebriate (including drug habitues); 6) diseased (including the tuberculous, the syphilitic, the leprous, and others with chronic, infectious, and legally segregable diseases); 7) blind (including those with seriously impaired vision; 8) deaf (including those with
seriously impaired hearing; 9) deformed (including the crippled); and 10) dependent (including
orphans, neer-do-wells, the homeless, tramps and paupers) (28).

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heal in another. The possibility of error in diagnosis would be sufficient to


prevent sterilization from being adopted (30, p. 70). He was also of the opinion that the majority of cases of cognitive disability were not a result of inheritance but caused by blastotoxins (alcohol, for example) or obstetric traumas
(30, p. 73).
Due to the influence of eugenics movements in Europe and the United
States, there existed in Brazil what one prominent psychiatrist described to me
as indiscriminate sterilization practiced by professionals in the 1930s and
early 1940s. The practice took place without official government support, but
neither did the government interfere. After World War II, sterilization was less
common, but always an available option. Doctors would share information
about shady procedures using informal networks. According to this psychiatrist,
older doctors would take younger doctors out for coffee or lunch and tell them
where to send patients for sterilization, lobotomy, or other illegal or scientifically questionable procedures. Psycho-surgery (such as lobotomy) was no
longer practiced in public hospitals after 1962, but still could be procured in
private hospitals. Sterilization was still conducted, although perhaps obscured
a record might note that a hysterectomy was performed due to infection, for
example.
According to several informants, psychiatric patients or those with cognitive disabilities were not consulted about the decision to sterilize. Either the
doctors made the decision or their parents requested the procedure. I was told
that the decision to sterilize was only made after careful evaluation of the patients cognitive level of functioning. Decisions were made case by case (cada
caso e um caso). One informant stated that he had never heard of cases of
leves (the high functioning, or borderline individuals) being sterilized, only
people so compromised that they were unaware of what was happening to
them. Several doctors and psychiatrists informed me that, during this time, sterilization was a medical fashion, just as tonsillectomy was once considered
acceptable. Just as tonsillectomy fell out of style, so too was sterilization passing out of mode. One administrator at a prominent psychiatric hospital believed
that the sterilization of patients was a means for the institution to ignore the
issue of sexuality and especially sexual abuse. If a patient became pregnant, it
was the responsibility of the hospital. If the patient was sterilized, then sex and
rape were rendered invisible.

GENDER AND SEXUALITY


After the decline of eugenics ideologies in Brazil, issues of sexuality and
cognitive disability disappeared popular and professional discourse until the
1970s. Although Brazilian psychiatrists in the 1920s and 1930s expressed con-

Sexuality, Parenthood, and Cognitive Disability in Brazil

15

cern about the sexuality of deviants, degenerates, and abnormals, specific


constructions of cognitive disability as a sexual and social threat never entered
the popular culture. This is a distinct contrast from the United States, where
countless books, movies, and television programs represent a continuous and
continuing presence of such images in the United States over the course of the
century. In Brazil, most individuals with cognitive disabilities lived with family
members, and thus were not subject to the increase incidence of sexual abuse
linked with institutionalization (31). However, sexuality must have been a concern of parents and professionalsit is an inescapable reality of human relations in any day or residential program for adolescents and adults with cognitive disabilitiesbut it was simply not discussed openly. This is not unique to
Brazil, sexuality as a human rights issue for individuals with cognitive disabilities was not discussed in the United States until the 1960s, and sexual abuse
was not discussed until the 1980s (32).
After the decline of the eugenics movement following World War II, eugenic sterilization and institutionalization disappeared from professional discourse in Brazil. Privately, however, professionals and parents remained concerned about the problem of sexuality. Many parents were insistent in
denying the sexuality of their adult children. Images linking cognitive disability
with a child-like and asexual nature were present in published accounts such as
Menino Sempre [Perpetual Child] (1977) by parent Yara de Oliveira Celentano
(33). Many parents in the United States held such beliefs, as well.7 Many Brazilian and American parents were overwhelmed and panicked by sexual manifestations ranging from masturbation and menstruation, to homosexuality and
sexual aggression.
In Brazil, sexual repression by parents and professionals was widespread
until the late 1980s, and is still common today. In the 1990s the issue of sexuality became a popular subject for conference seminars, with books and masters theses written on the subject (34,35,36). The discourse of professionals
changed, with classes, articles, and books stating that the sexuality of people
with cognitive disabilities was completely normal, and that individuals had the
same dreams and desires of anyone else of their social and cultural context
(37). Yet these normal impulses clashed with practices of many professionals
and most parents who remained controlling and repressive. Individuals with
cognitive disabilities were often held to rigid and repressive standards of sexual
morality.
The literature on sexuality in Brazil depicts a culture of eroticism and
sensuality linked to ideologies of race and originating from the social relations
7

Sexuality control by parents is common in the US and Brazil. I have seen several cases in both
countries where parents went to extremes to prevent their children from marrying. I have also seen
examples where parents have been tolerant and supportive of couples wishing to marry and even
have children.

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of slavery. Parker (1991) details the complex development of a dual sexual


culture in Brazil where the sexuality of white women was rigidly repressed, but
the sexuality of white men and black women were expressed openly (38).
Slaves from Africa were considered to be sexually degenerate and depraved,
although scholars such as Freyre (1956) later concluded that licentiousness
was the result of European practices developed in the social relations of slavery
(39). Parker states: Far from being the inherent product of a mongrel people,
the sexual character of Brazilian life was tied, not to miscegenation itself, but to
the social context which produced miscegenation (38, p. 25). Brazils openly
sexual culture provides stark contrast to the extreme conservatism practiced by
many parents of children with cognitive disabilities. Although it is accepted that
parents will often oppose the sexual activities of unmarried children (especially
daughters), people with cognitive disabilities lack the ability, opportunity, or
financial capacity to circumvent the sexual conservatism of their parents. They
often lack permission to date or the money to go to a hotel. Mostly, they lack
the social opportunity to meet people with whom a relationship might develop.
The concerns of parents and professionals vary depending on the gender of
the person with the cognitive disability. Fewer adult women cognitive disabilities participate in vocational programs because, if they have the skills, they are
kept at home to clean, cook, and care for nieces, nephews, or aging parents.
These women are allowed to perform such traditional roles (typical for any
unmarried daughter regardless of cognitive ability) but are not allowed, or not
considered capable of, having a sexual life. Some families control the social
interactions of their daughters to ensure that they will not be seduced. Parents
fear that immoral individuals will use their daughters sexually. It appears to be
a perception in modern Brazilian culture that women with cognitive disabilities
are passive and readily available sexual vessels. The novel, The Man in the
Monkey Suit [Homem de Macacao] (1986) by Oswaldo Franca, Jr., contains an
example of one such representation (40). One of the main characters in the
novel kept a mute woman tied to a rope for two days, so that she would be
readily available to him for sexual intercourse.
There are some representations linking cognitive disability with seduction
or prostitution, but only because the women have been corrupted. There are
no cultural representations in Brazil constructing the sexuality of women with
cognitive disabilities as a social threat. The strongest emotion I ever saw any
professional register concerning this problem was annoyance. If the women
are kept in a properly regulated environment and were obedient and biddable,
they are considered safe. Sterilization is sometimes a response to sexual activity, but more for the convenience of the family than from any perceived threat.
However, when interviewed some professionals continued to express concerns
about the transmission of pathological genes.
Boys and men with cognitive disabilities are judged by different standards.

Sexuality, Parenthood, and Cognitive Disability in Brazil

17

Mothers, especially those with conservative social and religious beliefs, are
often concerned with keeping their sons as well as daughters away from corrupting sexual experiences. However, fathers often consider the sexual experiences of their sons acceptable, as long as it is heterosexual experience. It is not
uncommon for fathers to bring their sons to visit prostitutes, sometimes with
regularity. The perception is that, in this one area, they can prove themselves
real men despite their disability. Professionals frown on the practice as more
likely to lead to sexual dysfunction than to encourage the development of
healthy (heterosexual) attitudes. I met several men with cognitive disabilities
whose families encouraged visits to prostitutes, including one adolescent who
was traumatized after his father forced him to visit one on his eighteenth birthday. Boys and men with cognitive disabilities are also vulnerable sexual exploitation by men and women in the community.
In A Problematica do Excepcional (1974), Dr. Aloysio A. DAbreu constructs the problem of sexuality, not as an issue of social threat or social
deviance, but rather as one symptom of a more general sexual repression present in the Brazilian culture. DAbreu documents the fears of parents, and also
the contradictory responses to that fear (41). Over two decades later, I received
some of these same responses from parents and professionals. DAbreu states
that, in 1974, the discussion (though not the practice) of sexuality is generally
repressed in Brazilian society, but especially in the case of the sexuality of
individuals with cognitive disabilities. Interviewing 100 parents (26 fathers and
74 mothers) of 88 exceptional children (21 girls and 67 boys) between the
ages of 5 and 35, DAbreu finds that in 18 cases, the children approached their
parents with questions related to sexuality and that in all cases inhibition was
the most evident reaction (41, p. 44). The following sexual issues are mentioned by parents as points of concern: menstruation, masturbation, heterosexual contact, homosexual contact, using parents or servants as objects of excitation, exhibitionism, using clothes or dolls for sexual ends, and visits to
prostitutes (41, p. 45).
In DAbreus study, parents show great concern over the issue of menstruation. Parents fear the child will be traumatized by this event, although
DAbreu notes the girls are far more likely to be traumatized not by the physiological event, but by the parents negative and panicked response to it.
DAbreu recommends that parents educate their daughters that menstruation
was just another natural bodily function and should be treated like other forms
of bodily eliminationwithout stigma, but in privacy. When asked about their
opinions concerning the sexual life of their children, the vast majority (89 out
of 100) show alarm and deny that their daughters would evidence such behavior. DAbreu finds that most of the parents are dissatisfied with their own sexual lives, and full of misinformation and fear regarding of their own and their
childrens sexuality. He notes that daughters are not as asexual as many of the

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parents assume, and that taking sons to prostitutes is always disastrous.


DAbreu states that the problematic originates neither from the individual
with the disability nor their sexuality, but rather from the attitudes and practices
of family members and society. He suggests that many parents project their
own sexual insecurities onto their child when they express fears that they are
not capable of controlling themselves sexually, that they are not capable of
being satisfied, that they will not know how to defend themselves, etc. (41,
p. 50).
In contrast to the parents, the professionals interviewed by DAbreu are
more accepting of the idea that adults with cognitive disabilities can have sexual lives. Solutions suggested by the professionals are indicative of the influence of an earlier age: Many suggested sterilization and the use of contraceptives to avoid pregnancy (41, p. 49). Although parenthood is not considered an
option, at least these statements indicated an acceptance that people with cognitive disabilities had a sexual life. DAbreus most significant departure from
earlier beliefs held by Brazilian professionals is a shift from biological to cultural explanations for the behavior of individuals with cognitive disability. For
DAbreu the problematic is not environmentally determined, nor an inherent
part of the nature of disabled individuals, but is rather a function of repressive
social and cultural contexts. This shift is representative of a general trend in the
second half of the twentieth century to move from biological to cultural explanations for social problems in behavioral health.
Unlike the United States and Europe, Brazil never established a structure
for the wide-scale institutionalization of children and adults with cognitive disabilities. However, it is inevitable that some children with disabilities enter the
child welfare system when orphaned or abandoned. Usually they are sent to
regular state orphanages or to the childrens (or chronic) wards of psychiatric
hospitals. Equally inevitable is their participation in or subjugation by the forms
of institutional sexuality prevalent in such gender-segregated institutions. Judgment difficulties and a desire to please (characteristics of cognitive disability)
increased the chances of individuals becoming targets for sexual exploitation.
When I interviewed them, some professionals expressed the belief that cognitive disability serves to shield individuals from the trauma of sexual victimization (the memory will fade . . .).
In the 1980s and 1990s some residential institutions attempted to prevent
abuse by segregating individuals diagnosed with cognitive disabilities from
normal children. This did not stop abusethe older, stronger, and higher
functioning individuals continued to victimize those younger and weaker than
them. In the 1990s collusion and silence was the usual institutional response to
abuse in Brazil. When visiting residential and psychiatric facilities in 1995
1996 I found that only one facility had adopted a formal procedure to investigate suspected abuse and rape and punish the perpetrators. In this case, the

Sexuality, Parenthood, and Cognitive Disability in Brazil

19

process has been used only in cases where the perpetrators are employees
there is no procedure to investigate patients abusing other patients. However, at
least this facility officially admits to the existence of abuse. Silence is far more
common. As stated above, historically some institutions have used sterilization
as a means to render heterosexual relations invisible. If no pregnancy resulted
from sexual relations (consensual or otherwise), then officially the relations
never happened.
Some professionals imply that abuse and incest only exists in families of
an inferior socio-economic-cultural level (42, p. 39). However, a venerable
Brazilian psychiatrist told me of one socially prominent man who raped his
cognitively disabled daughter and then institutionalized her in a psychiatric facility in order to hide the evidence. In the 1980s and 1990s the topic of sexual
abuse is virtually absent from the Brazilian literature, and some professionals
express the belief that it was not a problem in Brazil. Yet, twenty-seven out of
the thirty professionals that I interviewed on the subject have dealt with people
with cognitive disabilities who were sexually abused. These professionals feel
that this population is particularly vulnerable to sexual exploitation. During the
course of this research, I was told of dozens of cases of abuse and incest of
Brazilian adults and children with cognitive disabilities. In all cases the individuals know the perpetrators; they are family members, neighbors, fellowstudents, or other acquaintances.
Coelho (1987) locates the problems faced by individuals with cognitive
disabilities as products of social, economic, and cultural context. He discusses
abandonment, prostitution, and homosexuality as resulting from corrupting influences, and concludes that institutionalization in special schools for abandoned youth and psychiatric hospitals is no solution. On the issue of marriage,
he states that although choosing a partner and raising a family are considered
human rights, the issue is a complicated one, especially in the Brazilian context.
He believes that, depending on the level of functioning, some individuals might
be capable of marriage, but stresses the necessity of considering the emotional
maturity and financial security of the individuals. He states that marriage is
possible in developed countries because there is a social infrastructure providing adequate economic support for the individuals, and preparation and
training regarding birth control. However, in 1987 this did not exist in Brazil:
Given our [socio-cultural] reality, expecting the mentally deficient, even high functioning ones, to make good use of this condition is to lack the least bit of common sense and
to have a high level of irresponsibility. (42, p. 712)

Coelho states that in Brazil survival was difficult for those of average intelligence, and doubly difficult for those with cognitive disabilities.
People with cognitive disabilities who come from middle class backgrounds often encounter more substantial barriers to marriage and children,

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than those living in or near poverty. Prosperous parents have a greater ability to
control (and limit) the social lives of their children, since they can arrange for
constant supervision. Even if parents encourage their children to have typical
life experiences, there are virtually no opportunities for gainful employment
that would pay enough to support a middle-class lifestyle (this is a problem for
the Brazilian middle class as a whole, not just those with disabilities). The
responsibility for support falls entirely on the family, because the laws concerning social security for people with disabilities in Brazil are so tangled that it is
virtually impossible to qualify. Even if successful in wading through the bureaucracy, social security gives only a few hundred dollars per month. Parents
with enough money sometimes choose to support their married child with disabilities and any grandchildren who might follow. In some cases, parents make
sterilization a precondition before marriage is allowed. Such parents are considered liberal, since they are at least allowing their child to have a sexual life. I
was told of one case where a grandmother sought custody of her grandchild on
the grounds that the mother was incapable of caring for it. The judge supported
the mothers right to keep her child.
As Brazilian cultural attitudes become more tolerant of increased sexual
freedom, the idea of individuals with disabilities having sexual lives becomes
more acceptableat least for individuals with disabilities that are physical
rather than cognitive. By the late 1980s disability rights movements formed in
Sao Paulo and Rio de Janeiro. By 1981, groups begin exchanging information
and publishing papers containing extensive bibliographies concerning sexuality
and disability. Sexuality is recognized as a human right. This includes rights to
information, education, and training, the right to marry and have children, and
to receive community services such as counseling for family planning, marital
or sexual dysfunction, and genetic counseling (43, p. 9). At first these movements consist primarily of individuals with physical disabilities, but slowly people with cognitive disabilities become more involved. Marilda Novaes Lipp
(44) writes in support of the idea that with the appropriate education and training, individuals with cognitive disabilities are capable of fulfilling sexual relationships. She states that even the most dependent individuals are still sexual
beings with the same emotions, desires and impulses as other people. Lipp
derides the historical tendency of parents, professionals and society to ignore
this fact:
In this day and age this hypocrisy is falling to pieces and society is beginning to accept
the idea that all beings have the right to their sexuality as long as it is not used to the
detriment of others. (44, p. 8)

Lipp recognizes that individuals with cognitive disabilities are vulnerable to


sexual abuse, but stresses that parents should not allow fear of this possibility to
control and constrain peoples lives. However, her solution to the possibility of
unwanted pregnancy resulting from abuse is sterilization:

Sexuality, Parenthood, and Cognitive Disability in Brazil

21

It is necessary that these youths be protected from the wickedness of certain people, but
this should not prevent them from participating in activities with the family outside the
house. In the case of a young woman, when those responsible judge that they are not
able to totally protect her, a tubal ligation ought to be discussed with a doctor as a valid
alternative to an unwanted pregnancy. (44, p. 21)

Sterilization is offered, not a solution to sexual abuse, but as a response to the


inconvenience that an unwanted pregnancy might cause family members.
Francisco B. Assumpca o Jr. and Maria Helena Sprovieri (1989) also advise
sterilization in cases where women with cognitive disabilities are sexually active. Grounding their argument in theories of family, culture and society, they
conclude that individuals with cognitive disabilities lack the emotional and psychological capacity to form lasting sexual relationships, marriage, and family
(45). They advise sexual education, but unlike Lipp, believe that individuals
should be discouraged from marriage and procreation. Assumpca o and Sprovieri (1993) present case studies of ten married (or formerly married) couples
with cognitive disabilities (46). None of the unions lasted more than five years
and most caused great difficulties for family members and professionals. They
claim that many of the cases of rape and prostitution in Brazil involve cognitively disabled individuals of low economic status but admit that there were
no statistics to corroborate this assertion (45, p. 17). Yet, many individuals
without cognitive disabilities are also incapable of maintaining long-term relationships. If everyone were held to the standards set by Assumpca o & Sprovieri
and other professionals and family members, then probably most people would
be forbidden to marry or engage in sexual relationships.
Assumpca o and Sprovieri (1989, 1993) state that individuals with cognitive disabilities have difficulties in understanding the world, just as the world
does not understand the difficulties in social adaptation faced by these individuals (45,46). They show a complex understanding of the social barriers preventing individuals with cognitive disabilities from living normal lives. Though
they decry the injustice, their solution is not social change, but to recommend
instead that individuals with cognitive disabilities and their families accept the
existing constraints and learn to function within them. They judge individuals
with cognitive disabilities incapable of long lasting relationships and say that
their maternal instincts are underdeveloped. Thus Assumpca o and Sprovieri
(1993) strongly advocate sterilization and abortion for the benefit of responsible
family members and professionals (46). Although sterilization and abortion are
in most cases illegal in Brazil, many professionals have been working to change
this with regards to individuals with cognitive disabilities. Procedures do exist
to limit the civil rights of people with cognitive disabilities. If individuals are
interdicted (declared irresponsible in the eyes of the law) they lose their right
to marry, vote, and own property without an appointed guardian.
Despite the barriers depicted by the above authors some individuals with
cognitive disabilities manage quite well for themselves. They get jobs, marry,

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have children and live typical lives for people of their socio-economic backgrounds. The Brazilian social system may not be capable of supporting them,
but it is also incapable of preventing them. Probably the vast majority of those
who might be considered cognitively disabled (through diagnostic measurements) will never be in a position to receive an official diagnosis. Perhaps they
have lives where cognitive disability is not a handicap. In a context where
literacy is unnecessary for economic survival, and many people of all mental
abilities are illiterate, what does it matter if a person cannot learn how to read?
Some Brazilian professionals fight to keep individuals out of a system that
will segregate them from their family and familiar life. In one case, a group of
professionals wanted to send a young woman on a daily round-trip commute of
six hours in order to receive specialized educational services. The director
of the program argued that the woman was happy and functioning quite well in
her community with her family. If disability is a function of context, then the
director argued that this woman is not disabled. She did not want this woman to
commute six hours every day in order to learn how to be disabled. In contrast
to Assumpca o and Sprovieris research, twenty out of twenty-five professionals
that I interviewed on the subject believe that marriage by individuals with cognitive disabilities can succeed when given the appropriate support. Eighteen out
of twenty feel that raising children is also possible, with support. Many of these
professionals know of couples with cognitive disabilities that have succeeded in
both marriage and parenthood.
Beginning in the late 1980s, researchers such as Rosana Glat (1989, 1992)
and her students Arthur Militao (1991) and Ada Martinelli Saraiva (1993) have
asked individuals with cognitive disabilities for their opinions on life issues
such as sexuality and marriage (34,35,36,37). Glat collected the life histories of
35 women with cognitive disabilities of different ages and social backgrounds,
asking questions about all aspects of their daily lives, including family, work,
friendships, and romance, and their perceptions of their own disabilities. Like
Lipp (1986), Glat stresses that individuals with cognitive disabilities do not
differ from anyone else in their desire for sexual and nonsexual relationships.
The only difference is the intense repression experienced by these individuals.
Glat (1989) finds that women with cognitive disabilities are receiving messages
from family and professionals that marriage, children and an active sexual life
are not for you (34, p. 131). The women respond to this repression by having
hidden romances. Glat states:
Perhaps one characteristic of this group of women with mental disabilities that might be
considered atypical, (at least by the norms of Rio de Janeiro), is how little actual physical contact with men there is in the so-called sexual relationships that they maintain. The
majority of those interviewed spoke of their romances in a quite ingenuous and platonic
manner that is definitely not common nowadays. (34, p. 129)

Yet some of the women interviewed do express a desire for marriage and children. Glat provides examples of the desire and subsequent familial repression.

Sexuality, Parenthood, and Cognitive Disability in Brazil

23

(. . .) Now, his mother doesnt want to know anything about romance or marriage.
She doesnt? Why doesnt she want to know anything?
Ah, its that his mother always says to me that he, that he is an innocent man, I also am
an innocent, because we are, are exce, exceptional, we cant marry.
And you really want to get married?
No, I cant marry him. He wants to, now but I cant marry.
Is that so? Why cant you marry, Ivone?
Its like this, I cant marry because, because of my mother. Because of our, because of
our, like, its, its, retardation (silence). Its because of this that we cant marry.
You said that you cant have children, is that it?
Thats so.
Thats so, but you can get married.
Thats what he wants.
Ah, he wants to marry, but he doesnt want children. Or is it that he wants children?
He wants to have children, he wants to have children in this life. Now but it happens that
we cant that I already told him this, like with my mother, then my mother just said that
she doesnt want this.
That she doesnt want you to have children?
Of course. (Ivone, 35 years) (34, p. 134)

Glat finds that individuals with cognitive disabilities are being held to standards
of behavior that people without disabilities would find difficult to maintain.
One of Glats informants claims her family treats her the same way they treat
her sisters, but she is the only sister who has been sterilized, despite the fact
that her behavior is probably not all that different from that of her siblings.
Sexuality has become a fashionable topic and is being discussed with more
frequency and openness than in the past, but it is questionable whether practices
are changing. During the course of my observations and interviews, professionals who speak progressively often act repressively, although it is hard to
discern whether this is because of their own professional feelings or whether
they are just following institutional policy. Founding family members who are
now over the age of seventy control policies on sexuality at the vocational
organizations that I visited. The policies at these facilities lag far behind the
current professional discourse. There is a generation gap between the foundercontrolled administration, the younger parents whose children were currently
receiving services, and the professionals employed within the organization.
However, it is impossible to generalize. Two of the most liberal parents interviewed were a couple in their 70s. She was one of the founders of one of the
oldest parent-led agencies. He was a Brigadier General, and for a time, a high
placed official in the military dictatorship. Yet, when I asked about their sons
social life, they told me that they kept completely out of it. He lived at home,
and came and went as he pleased. Sometimes he was gone for days. They
thought he had a girlfriend, but did not ask, feeling that it was his business and
he would share information with them if and when he wished. Based on interviews with 25 men and 26 women, Glat (1992) states that, although all individuals with cognitive disabilities had fewer social opportunities than others, this
was even more the case for women more than for men (37). She credits this to
traditional gender roles that allowed men greater social freedom than women.

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Thus, while 35% of the women reported being kissed, 52% of men reported one
sexual encounter (37, p. 678).
Glat states that the inappropriate behavior witnessed in individuals with
cognitive disabilities originates, not from the disability but from the structure
of life and education in the wider sense of the word, that these people generally
receive! (37, p. 69). She challenges the assumption that individuals with cognitive disability of whatever degree have more in common with each other than
with so-called normal individuals. She concludes:
Thus, it can be affirmed that it is infantilization and social isolation, and not their
intellectual quotient or neurological problem that prevents them from enjoying a full and
satisfying love life. The result is terrible solitude to which the majority of people with
mental deficiency are condemned, principally when they reach adulthood. (37, p. 72)

Most articles published in the 1990s (47,48,49) concur, to a great or lesser


extent, with Glats assertions. The working group coordinated by Sadao Omote
(1993) concludes that special education instructors are ill prepared to teach and
counsel their students on the issue of sexuality. As a result, professional practice has been inconsistent: professionals might recognize intellectually that individuals with cognitive disabilities have the same sexual needs as anyone else,
but are afraid of the consequences of allowing any manifestations to occur
(47). Professionals may also fear parental reactions. Ribeiro and Nepamuceno
(1992) report that parents sometimes resort to extreme actions to prevent their
adult children from having sexual lives:
One of the students, 33 years old at the moment of this observation, was a victim of
sexual repression on the part of her parents when she was an adolescent . . . this woman
suffers the consequences of the totally inappropriate manner that the parents and our
own institution dealt with the situation to this day.
When 17 years old this woman had sexual relations, and it happened that this fact
was discovered by her parents. They gave her a beating, took her out of the institution
and locked her up inside the house for years. She was even forbidden to leave without
her parents. She never even went to the front door.
Currently she has been returned to the institution, and when someone speaks about
sex near her, she covers her ears and starts to cry. She will not allow anyone to change
clothes in front of her, and she screams and cries desperately if scenes appear on soap
operas or television films with couples kissing, speaking words of love, in the nude, or
having sexual relations. (48, p. 168)

I was told of a mother who, upon learning her daughter had been sexually
active, placed a hot hard-boiled egg in her vagina as punishment.
While sexuality was not the only, or even the most obvious example where
parents and professionals misused their authority, it provides some powerful
examples. There is something about the nature of cognitive disability, both in
Brazil and in the United States, that leads parents and professionals to assume
they are justified in having complete control over the fates of their children or
charges (50). Unfortunately, in both countries, cases where important life decisions were made by the individuals themselves, rather than by parents or pro-

Sexuality, Parenthood, and Cognitive Disability in Brazil

25

fessionals, are the exception rather than the rule. In the United States, selfadvocacy movements have formed in the last two decades. Individuals with
cognitive disabilities are now demanding the right to control their own lives and
make their own decisions. A few such groups also exist in Brazil, but some of
those that I observed had become just another medium for professionals to
castigate and criticize the actions (particularly sexual and antisocial behavior)
of the group members. Thus the groups meant for self-actualization are transformed into another means of social control. However, this is not always the
case. Indeed, I was told of one case where the adult students of a vocational
day program successfully lobbied to change institutional policy and be allowed
to have (heterosexual) romances, that could (in socially appropriate ways) have
expression in public.
Because higher functioning adult women are more likely to be kept at
home to care for family, one vocational facility were I conducted research had
more than four times the number of men than women in attendance. Although
there had recently been moves to reintegrate gender-segregated vocational activities, the majority of the women still worked at gender-traditional tasks such
as sewing, weaving, knitting, and embroidering, while the majority of the men
worked at painting, woodworking, printing, and bookbinding. The professionals
were interested in desegregating the workshops not just to broaden the experiences of the women, but because they wanted to avoid all-male situations.
Large amounts of time and energy were spent discouraging men from engaging
in sexual activities with each other. Professionals feared that the individuals
most often engaging in these behaviors would contaminate others, and hoped
that the presence of women in every workshop would inhibit the mens behavior. There were few sanctioned ways that sexuality or romance could be expressed. Homosexual activity was especially discouraged, but heterosexual romances were also repressed. A woman who was flirtatious was seen as a
troublemaker.
According to the professionals that I interviewed, young women and men
transferred into adult vocational facilities have to be trained regarding the
rules of acceptable conduct. They are told: This is a professional work situation. No romance is allowed. If you want to romance, do it somewhere
else. One psychologist states that new students can be a little wild at first,
but usually calm down after they learn the rules. Many individuals attending
the facility that I studied had boyfriends and girlfriends in the community, but
the majority were not allowed the social freedom, opportunity, or privacy. The
vocational center was the only social space many of them had outside of home
and family. Some chose to use this opportunity to do what they could.
I interviewed dozens of professionals: psychiatrists, psychologists, educators, doctors, social workers, physical, occupational, and speech therapists. I
found responses to questions regarding sexuality and cognitive disability to be

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very inconsistent. Some old-guard psychiatrists were very progressive in their


attitudes, discussing social and cultural contexts. Meanwhile, some young professionals told me that individuals with cognitive disabilities had a flora da
pele (were easily excitable with hyper-sensitive sexual responses). Although
the literature on sexuality is remarkably consistent in its progressivism, there is
no indication of a unified professional practice in Brazil. Responses to the issue
of sexuality are extremely individualized, not just on the level of cada caso e
um caso (each case is unique) but depending on the training, religion, and
personal opinions individual professionals. There does seem, as a whole, to be a
certain amount of generational shift in regard to parental and professional perceptions (younger parents and professionals are often more accepting), but even
this is often less a factor of age than of personal opinion. As I remarked earlier,
some of the older parents and professionals are very open-minded, and some of
the younger parents are quite repressive.
Despite the relative rarity of extreme repressive measures of sterilization
and institutionalization, I saw the affects of powerlessness on the women with
cognitive disabilities that I befriended in Brazil. I saw the unhappiness caused
by infantilization, social and sexual repression, exclusion and isolation. However, such practices were never legislated or mandated by the State, nor did
they become incorporated into the popular culture (as was the case in the
United States). As institutionalization was never common, women with cognitive disabilities are not perceived as alien or unnatural in a threatening way.
Brazilian men and women with cognitive disabilities are sometimes perceived
as sexual vessels to be used at will, and sexual abuse did occur. However, the
fact that most women live with their families, rather than in institutions, significantly lowers the possibility of sexual victimization (31). In Brazil, the stigma
of disability is enmeshed within established and well-recognized (and researched) power hierarchies of gender, class and race. Sexual repression exists,
but unlike in the United States, it never included an ethos of sexual threat.
Women with cognitive disabilities were never commonly perceived as sexual
monsters that needed to be controlled for the good of society. However, the fact
that women are still kept sheltered from significant life experiences, including sexual relationships, marriage, and procreation, does indicate a struggle
between social marginality and citizenship.

ACKNOWLEDGMENTS
This research was in part funded by a 1995 United States Department of
Education Foreign Language Area Studies Fellowship. The author gratefully
acknowledges the stories shared by the dozens of Brazilian practitioners and

Sexuality, Parenthood, and Cognitive Disability in Brazil

27

parents of people with disabilities that were interviewed during the course of
this research.
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