Vera Lucia Pereira Alves

The phenomenological-existential comprehension of chronic pain: going beyond the standing healthcare models

A distinguishing characteristic of the biomedical model is its compartmentalized view of man. This way of seeing human beings has its origin in Greek thought; it was stated by Descartes and to this day it still considers humans as beings composed of distinct entities combined into a certain form. Because of this observation, one began to believe that the focus of a health treatment could be exclusively on the affected area of the body, without the need to pay attention to patient’s subjectivity. By seeing pain as a merely sensory response, this model was not capable of encompassing chronic pain, since the latter is a complex process that can occur independently of tissue damage. As of the second half of the twentieth century, when it became impossible to deny the relationship between psyche and soma, the current understanding of chronic pain emerges: that of chronic pain as an individual experience, the result of a sum of physical, psychological, and social factors that, for this reason, cannot be approached separately from the individual who expresses pain. This understanding has allowed a significant improvement in perspective, emphasizing the characteristic of pain as an individual experience. However, the understanding of chronic pain as a sum of factors corresponds to the current way of seeing the process of falling ill, for its conception holds a Cartesian duality and the positivist premise of a single reality. For phenomenology, on the other hand, the individual in his/her unity is more than a simple sum of parts. Phenomenology sees a human being as an intending entity, in which body, mind, and the world are intertwined and constitute each other mutually, thus establishing the human being’s integral functioning. Therefore, a real understanding of the chronic pain process would only be possible from a phenomenological point of view at the experience lived by the individual who expresses and communicates pain.ResumoUma característica marcante do modelo biomédico é a visão de homem compartimentalizada na qual se embasa. Esta forma de ver o ser humano teve origem no pensamento grego, foi afirmada por Descartes e permanece até hoje como sendo este ser composto por entidades distintas que se combinam em determinada sorte. Como fruto desta constatação passou-se a acreditar que o foco da atenção de um tratamento de saúde poderia ser dado especificamente à área do corpo acometida, sem que fosse necessária atenção à subjetividade do doente. Compreendendo a dor como mera resposta sensorial, este modelo não pôde alcançar o que seria a dor crônica, por esta se tratar de um processo complexo podendo existir independente de lesão tecidual. A partir da segunda metade do século XX, quando se torna impossível negar a interferência entre psique e soma, surge a compreensão de dor crônica que se tem hoje: de uma experiência individual, resultado de uma soma de fatores físicos, psicológicos e sociais, não podendo por isso ser abordada de modo desvinculado ao indivíduo que a expressa. Este entendimento permitiu um grande avanço de ponto de vista por ressaltar sua característica de vivência particular. Entretanto, a compreensão de dor crônica enquanto soma de fatores faz jus ao modo atual de compreensão do adoecimento mantendo em sua concepção a dualidade cartesiana e a premissa positivista de se voltar a uma única realidade. Para a fenomenologia, em contra partida, o indivíduo em sua unidade é mais que a mera soma de partes. Entende o ser humano como entidade intenciona l, onde corpo, mente e mundo são entrelaçados e constituem-se mutuamente, estabelecendo, assim, um tipo de funcionamento completamente integral do ser humano. Deste modo, o real entendimento de um processo de dor crônica só seria possível a partir de um olhar fenomenológico da experiência como vivida pelo indivíduo que a expressa e comunica.

Emoção e soma (des)conectadas em páginas de revista: as categorias temáticas do discurso prescritivo sobre os fenômenos da vida e da doença

As revistas vendidas nas bancas tem se tornado textos de autoajuda e o estudo de suas materias possibilita compreender como seus discursos sao construidos, como se tornam repertorios utilizados para dar sentido a vida. No caso das revistas que versam sobre a esfera da saude, que prescrevem receitas de tratamento, prevencao e ate estilos de vida saudaveis, os estudos permitem compreender os significados dos discursos sobre corpo e saude. Em algumas materias, por vezes o destaque dado ao fisico se faz acompanhar da insercao de aspectos mentais. Tal fato originou o presente estudo que tem por objetivo clarificar como esta conexao mente e corpo e conceituada e prescrita nessas paginas. Seis materias de uma revista brasileira de saude, publicadas entre agosto de 2005 e fevereiro de 2006, foram analisadas quanto ao conteudo dos textos e ao destaque grafico e textual. Considerou-se significativo o formato em que esta midia opera, pois associado as categorias tematicas: autodiagnostico, o lugar das emocoes, as prescricoes e a causalidade reforca estilos de vida saudaveis. Para tanto o leitor deve aprender a se autodiagnosticar e controlar suas emocoes, consideradas contrapostas ao fisico. As materias delineiam um campo de saude em que a cisao mente corpo se adensa e se prolonga, instaurando a medicalizacao da sociedade.

Significados do adoecer para pacientes com lúpus eritematoso sistêmico: revisão da literatura

Systemic lupus erythematosus is an autoimmune disease that causes many psychological repercussions that have been studied through qualitative research. These are considered relevant, since they reveal the amplitude experienced by patients. Given this importance, this study aims to map the qualitative production in this theme, derived from studies of experiences of adult patients of both genders and that had used as a tool a semi-structured interview and/or field observations, and had made use of a sampling by a saturation criterion to determine the number of participants in each study. The survey was conducted in Pubmed, Lilacs, Psycinfo e Cochrane databases, searching productions in English and Portuguese idioms published between January 2005 and June 2012. The 19 revised papers that have dealt with patients in the acute phase of the disease showed themes that were categorized into eight topics that contemplated the experienced process at various stages, from the onset of the disease, extending through the knowledge of the diagnosis and the understanding of the manifestations of the disease, drug treatment and general care, evolution and prognosis. The collected papers also point to the difficulty of understanding, of the patients, on what consists the remission phase, revealing also that this is a clinical stage underexplored by psychological studies.

Emotional Experiences of Obese Women with Adequate Gestational Weight Variation: A Qualitative Study.

Background As a result of the growth of the obese population, the number of obese women of fertile age has increased in the last few years. Obesity in pregnancy is related to greater levels of anxiety, depression and physical harm. However, pregnancy is an opportune moment for the intervention of health care professionals to address obesity. The objective of this study was to describe how obese pregnant women emotionally experience success in adequate weight control. Methods and Findings Using a qualitative design that seeks to understand content in the field of health, the sample of subjects was deliberated, with thirteen obese pregnant women selected to participate in an individual interview. Data was analysed by inductive content analysis and includes complete transcription of the interviews, re-readings using suspended attention, categorization in discussion topics and the qualitative and inductive analysis of the content. The analysis revealed four categories, three of which show the trajectory of body care that obese women experience during pregnancy: 1) The obese pregnant woman starts to think about her body;2) The challenge of the diet for the obese pregnant woman; 3) The relation of the obese pregnant woman with the team of antenatal professionals. The fourth category reveals the origin of the motivation for the change: 4) The potentializing factors for change: the motivation of the obese woman while pregnant. Conclusions During pregnancy, obese women are more in touch with themselves and with their emotional conflicts. Through the transformations of their bodies, women can start a more refined self-care process and experience of the body-mind unit. The fear for their own and their babys life, due to the risks posed by obesity, appears to be a great potentializing factor for change. The relationship with the professionals of the health care team plays an important role in the motivational support of the obese pregnant woman.

[Emotion and soma (dis)connected in magazine pages: the thematic categories of the prescriptive discourse on phenomena of life and illness].

Magazines sold on newsstands have become self-help texts, and the study of the topics covered makes it possible to understand how the discourses are constructed, how they become repositories used to give meaning to life. In the case of magazines that deal with the sphere of health, prescribing methods of treatment, prevention and even healthy lifestyles, the studies allow us to understand the meanings of discourses about body and health. In some articles, the emphasis that sometimes highlights the physical aspect is accompanied by the inclusion of mental aspects. This fact gave rise to this study, which seeks to clarify how this mind-body connection is conceptualized and prescribed in these pages. Six articles of a Brazilian health magazine published between August 2005 and February 2006 were analyzed regarding the content of the texts as well as graphic and textual features. The way this media format operates was considered significant, and when associated with the themes: self-diagnosis, the place of emotion, the prescriptions and causality reinforce healthy lifestyles. Readers must learn to self-diagnose and control their emotions, considered to be juxtaposed to the physical emotions. The articles outline a field of health in which the mind-body split deepens and extends, establishing the medicalization of society.