Paulo Amarante

Protagonismo e subjetividade: a construção coletiva no campo da saúde mental

This paper is a reflection on the origins as well as conceptual and historical bases of the production of subjectivity by the subject that is considered insane. The importance of the concept of mental alienation in the shaping of the social place of insanity in modern society is analyzed in parallel with the constitution of an alienated subject, incapable of subjectivity or desire: a non-subject of medicalized insanity. Then, after an elaboration about the genealogy of subjectivity, a reflection is presented on the current practices in the field of mental health that aim at the collective construction of the subject of insanity no longer as an alienated subject but as a protagonist, which means a new social relationship with insanity.

Novos sujeitos, novos direitos: o debate em torno da reforma psiquiátrica

The author analysis and talks about the discussion of the process of Brazilian Psychiatric Reform and Paulo Delgados legislation, which proposes new technologies in mental health care that substitutes the psychiatric hospital. To the author, the concept of de-institutionalization in opposition to desospitalization, defines better the ethics aspects in mental health care.

Perfil demográfico e sócio-econômico da população de internos dos hospitais psiquiátricos da cidade do Rio de Janeiro

Knowledge on the characteristics of patients admitted to psychiatric hospitals is essential to adequate care, yet such information is not always available. A survey was conducted on patients in the 20 psychiatric hospitals in the city of Rio de Janeiro, Brazil. This paper presents demographic and socioeconomic data on the study population: 3223 persons (66.0% male; 52.6% under 40) on October 24, 1995. 73.8% had not finished elementary school; 25.5% were illiterate. 71.6% of the males and 61.1% of the females were single. Both groups had the same divorce percentage (13%). 43.1% of patients had jobs at the time of first admission, but only half had kept them by the time of this survey. Some 50% of the patients only received visits at extended intervals or not at all. This finding, plus the fact that 37.4% had been hospitalized for more than one year and 65. 1% did not leave the hospital during holidays or weekends, provides a picture of their social isolation. The findings are discussed based on epidemiological data, and hypotheses are suggested to explain some of the results.

Desafios para os Centros de Atenção Psicossocial como serviços substitutivos: a nova cronicidade em questão

Este artigo advem de uma pesquisa exploratoria, de base qualitativa, realizada em um Centro de Atencao Psicossocial (Caps) do Rio de Janeiro, com o objetivo de compreender a producao da nova cronicidade. Alem da observacao participante, foram realizadas entrevistas semiestruturadas com tecnicos, usuarios e familiares, tendo como base para analise dos dados a teoria do construcionismo social. Os resultados mostram que os entrevistados tem perspectivas que vao ao encontro da ideia de nova cronicidade, expressao que colaborou para uma analise do funcionamento, dos avancos e desafios encontrados nesse servico.

[An adventure in the insane asylum: the life of Franco Basaglia].

The process of change in the mental health field and psychiatric reforms bear a close relationship to practical and theoretical issues stemming from Franco Basaglias experience. This article is intended as a reflection on Basaglias career, stressing the main concepts and theoretical references he worked with and seeking to trace the unique nature of his contributions to the current project for de-institutionalizing psychiatry. Basaglia produces a break by profoundly challenging psychiatric knowledge and institutions, thus allowing for a new epistemological framework (a framework that was thus also new in relation to culture and mental health care) in dealing with insanity. Based on the observation that Basaglias work is little known, this article attempts to revisit his thinking, highlighting the unique nature of his contributions and stressing the need for a better understanding of his work by those who are devoted to the field of mental health and social institutions.

Estudo sobre práticas de cuidado em saúde mental na Atenção Primária: o caso de um município do interior do estado do Rio de Janeiro

Objective This study aimed to understand/discuss the development of approaches that emerged as demands on mental health in the physician practice in these health facilities. The research was guided by three analytical categories comprised by: the practice of medical professionals who assist users of the Family Health Strategy; the relationship with mental health issues, the ability of a more holistic view of the community attended and the relationship with the use of psychopharmacological drugs. Methods We conducted semi-structured interviews with medical professionals and the data collected was analyzed using discourse analysis. The texts were read thoroughly and broken down into fragments that were grouped by themes matching the study intentions and objectives. Result The study showed, among others, that the relationship doctors-assisted community in general is still connected to a clinic-institutional vision that does not favor some issues of identity, culture and social movements in the communities. We noted the lack of practices aimed at the empowerment of the subjects on their living conditions, health and subjectivity.

From manicomial logic to territorial logic: Impasses and challenges of psychosocial care.

The present study describes Psychosocial Care as a new paradigm currently operating within the Brazilian Psychiatric Reform, emphasising one of its key elements: the provision of mental care within a network and a territory. To this end, the social and cultural diversity of each territory is taken as fundamental aspects to enable appropriate care for mental suffering, overcoming exclusionist thinking patterns that recently have taken on worrying conservative manifestations, and eliminating misconceptions about what defines a mental health sufferer, as well as those who choose alternative ways of being.

Memória de um movimento: a revista Saúde em Debate e a reforma sanitária brasileira

This article traces significant moments in the history of the magazine Saúde em Debate - sourcing references and information from documents, historical studies, editions of the magazine, academic work and interviews with physicians and writers who contributed to its creation. In its 39 years of existence, although there may have been variations in the magazines editorial policy, its role as a means for exchange of ideas and debate on critical health thinking, and making a contribution by in some way intervening in the Brazilian political process, has not changed. The magazine established itself with a firm reputation as a vehicle of scientific communication especially in the areas of health policy and management, expanding the scope of subjects over time. Among the challenges it has faced, as well as that of financial sustenance, has been its role as an instrument for dissemination of Latin American thinking in the field of health.Resumo Neste artigo apresentamos momentos significativos da trajetoria da revista Saude em Debate. Para isso utilizamos documentos, estudos historicos, numeros da revista, trabalhos academicos e depoimentos de sanitaristas que contribuiram para a sua criacao. Nesses 39 anos de existencia, embora possam ter ocorrido variacoes na politica editorial da revista, o papel de ser um meio de intercâmbio e debate do pensamento critico sanitario e de alguma forma intervir no processo politico nacional, nao se alterou. A revista consolidou-se como um veiculo de comunicacao cientifica, especialmente nas areas da politica e da gestao em saude, ampliando o escopo tematico ao longo do tempo. Entre os desafios da revista, alem de sua manutencao financeira, esta em tornar-se, tambem, um instrumento de difusao do pensamento latinaomericano do campo da saude.

Estudo sobre o processo de medicalização de crianças no campo da saúde mental

O presente artigo demonstra o resultado final de uma pesquisa que visou aproximar-se de um servico de saude e analisar os fatores que contribuem para a medicalizacao infantil em saude mental, buscando compreender como questoes inerentes ao cotidiano da vida de uma crianca se tornam problemas medicos. Para tanto, foram analisados os prontuarios de criancas atendidas pelo servico durante o ano de 2008, destacando: demandas iniciais, presenca de diagnostico e praticas adotadas pelos atores envolvidos. Foi possivel confirmar a hipotese de que a medicalizacao se faz presente no dia a dia das criancas, observando-se, por exemplo, questoes como mau comportamento sendo tratadas como doenca.

A reforma psiquiátrica no SUS e a luta por uma sociedade sem manicômios

T This article presents a historical and epistemological study of the construction of public policies about mental health and psychosocial care in Brazil´s Unified Health System, the SUS. To that end, it proposes an approach that identifies actions and strategies related to social participation in the construction of policies, one of the founding principles of SUS, seeking to delineate its importance in the specific trajectory of the psychiatric reform process. Subsequently, it highlights the originality and importance of actions that used culture as a means and as an end, in the sense of not restricting psychiatric reform to a transformation limited to public services or health in the strict sense of the term, emphasizing the principle of construction of a new locus in society for madness. Finally, it provides a historical follow-up of the promulgation of mental health policies in Brazil, identifying the most important initiatives and their impacts on the transformation of the care model, and concludes by questioning the conservative restructuring that is currently taking place.