Thirty years ago, the British Journal of Psychiatry published a controversial lecture by Professor Michael Sheperd, which unveiled Emil Kraepelin's contributions to racist degeneration theories.^{Reference Shepherd1} Two decades ago, this journal published a groundbreaking editorial regarding racism and psychiatry, authored by Professor Peter Tyrer.^{Reference Tyrer2} Since then, this very sensitive topic has become more and more visible, discussed in several opportunities and under multiple aspects, particularly concerning the pervasiveness and chronicity of structural racism in research and university institutions in Western countries.

A century ago, Albert Einstein visited South America. In Rio de Janeiro, he was hosted by Juliano Moreira [1872–1933] (Fig. 1), one of the most distinguished Brazilian scientists of that time, who became the Emeritus President of the Brazilian Academy of Sciences. The only son of a former enslaved woman, Moreira is regarded as one of the founding fathers of scientific psychiatry in Brazil.^{Reference Fikes and Cargille3–Reference Nardi, Carta and Shorter5} Considering historiographic evidence,^{Reference Jacobina6–Reference Oda8} how could a poor Black person manage to overcome the structural racism and coloniality of Brazilian society?

Fig. 1 Juliano Moreira [1872–1933].

A child prodigy, Moreira was accepted at the Faculdade de Medicina da Bahia in 1886, two years before the abolition of slavery in Brazil. He graduated in 1891, at 19 years old, with a thesis titled The Aetiology of Early Malignant Syphilis, highlighting the role of ‘physiological misery’ in disease causation.^{Reference Jacobina6} In 1896, Moreira was approved with honours for the chair of Clinical Psychiatry and Nervous Disorders against those who opposed a ‘mulatto’, to become a professor at the renowned faculty.^{Reference Jacobina6} He soon joined the Tropicalist School of Bahia, as editor-in-chief of the Gazeta Médica da Bahia, then the most important medical scientific journal in Latin America.^{Reference Schwarcz7}

In 1899, Moreira travelled to Europe for pulmonary tuberculosis treatment, and attended courses in mental medicine in England, France, Italy, Austria and Germany. Pioneeringly, he embraced Kraepelinian nosology and Freudian psychoanalysis.^{Reference Nardi, Carta and Shorter5} Returning to Bahia with a vision for reform, his attempts to modernise medical training and conduct research in local institutions were met with resistance and racial prejudice.^{Reference Jacobina6–Reference Oda8} Undeterred, Moreira moved to Rio de Janeiro in 1903, the capital of Brazil at that time, and never went back to Bahia.^{Reference Jacobina6} Appointed director of the Hospício Nacional de Alienados, he used the opportunity to apply Kraepelin's nosology outside Europe, transforming the institution into a humane, science-oriented therapeutic space.^{Reference Jacobina6}

Moreira was a founding member of the Brazilian Academy of Sciences in 1916 and later became its Emeritus President. From this position, he was a vocal critic of the scientific status quo, stating that, in Brazil, often ‘unfounded assertions are accepted in science without proper examination’.^{Reference Jacobina6} His rise to the forefront of Brazilian science is indeed a testament to his extraordinary talent. Moreira died of complications of pulmonary tuberculosis on 2 May 1933 in the city of Petrópolis.^{Reference Jacobina6}

Juliano Moreira may have been a case of ‘exceptional racism’, which is a disguised, perhaps refined form of structural racism. We propose to call ‘exceptional racism’ the strategy of socially and institutionally praising outstanding people (persons who are exceptions, extraordinary personalities) from oppressed groups as a way of denying or covering up racism on ideological and political grounds. Such strategies imply an overt, often disproportional, overvaluation of talents as exceptions. Brazilian history has plenty of such examples: Machado de Assis in literature, Teodoro Sampaio in engineering, Luiz Gama in law, Candido Rondon in the military and Juliano Moreira in medicine. All were Black people of poor background celebrated in national history as a demonstration that it would only take talent, effort and dedication to succeed in a proto-liberal, racist society. The case of Dona Yayá, a wealthy landowner treated by Moreira,^{Reference Di Lotti9} who regularly travelled to São Paulo to assist her, is an eloquent example of how the elite valued his capacities despite his being a Black doctor.

The emergence of Brazilian medicine was inextricably linked to the nation's racial dynamics, marked by the lingering shadow of slavery.^{Reference Schwarcz7} Theories of degeneration, prominent during the 19th century, posited that miscegenation between races at different evolutionary stages would lead to societal decay.^{Reference Schwarcz7,Reference Oda8} Studies on human degeneration in Brazil were promoted as a way of legitimising social and political hierarchies then in force.^{Reference Oda8} Emil Kraepelin, Moreira's scientific correspondent, eventually advocated degeneration theories and eugenics, which composed Nazi medical ideology.^{Reference Shepherd1} Kraepelin's influence on Moreira's work and the biometric references of Lombrosean physical anthropology reinforced stereotypes of the racist theories of his time. However, Moreira challenged the racialised application of these theories and elaborated a sociobiological counter-discourse of his own.^{Reference Nardi, Carta and Shorter5} Along this path, he rejected genetic explanations for somatic and mental ailments among Black populations. Analysing hospital data, he explored environmental and behavioural factors, actively confronting degeneration theories by arguing that mental suffering should not be attributed to racial factors but rather to poor education and living conditions.^{Reference Nardi, Carta and Shorter5,Reference Jacobina6} In this way, Moreira was a pioneer in studying the social determinants of mental health.

Nevertheless, open discrimination and racial segregation surely made up part of his personal and professional life. Biographers have not clarified the reasons why he resigned from his academic position in Bahia and decided to move to Rio de Janeiro. His move could simply have been in search of better treatment for his poor health or disappointment with refusal of his proposed reforms. Perhaps even more plausible an explanation is that he was trying to run away from a racist social, professional and academic environment.

Moreira's exceptional journey from offspring of slavery to a pioneering figure in modern neurosciences in his country reflects both the triumphs and struggles of Black individuals in the pursuit of medical excellence. However, his enduring legacy extends far beyond his personal achievements within a predominantly White, racist medical establishment. By shedding light on Moreira's life, we can better understand the historical role of racialism in shaping scientific medical progress in a social and institutional peripheral environment, still plagued by racism and other oppressive traits of coloniality.