Políticas públicas em saúde, vulnerabilidade e discriminação negativa: o serviço de saúde mental em Araguaína/TO

Abstract

The dissertation brings the problematization and the analysis of what is advocated by the public policies in mental health that consubstantiate the Psychiatric reform in Brazil, betting on the premise that the practices in the institutions substitutive to the asylums repeat the previous logic, that is: through the medicalization, do not offer an incisive service to those who seek psychosocial attention, keeping them in a condition of social vulnerability. Therefore, the perception of servers and users about concepts and practices within CAPS II and CAPS AD III of Araguaína-TO was chosen as the research object. The general objective was to problematize this perception, ascertaining whether, in the service process, users are kept in a condition of vulnerability, due to the fragile management of public health policies. It is questioned: despite the advances of the Public Policies of Mental Health, the medicalization still overlaps in the CAPS and in what sense expresses correlation with the vulnerability? As a result, it is hypothesized that the medicalization overlaps, since it does not consider the notion of the subject of desire and due to the tamponamento of the symptoms, the diagnostic labeling and the non-implication of the subject, maintains the condition of vulnerability of the user. This study investigated the observance of what was described as an objective of the reform for mental health actions, using the concepts of Freudo-Lacanian psychoanalysis, especially in relation to the ethics of psychoanalysis and the view of subject of desire, as well as those of zones of transition to social cohesion of Robert Castel, which is constituted by a set of processes that govern the relations of work and the place that each person occupies in the social context. According to the author, the individuals are positioned within a structure composed of three premises: zone of integration, zone of vulnerability and zone of disfiliation. In this context, it is necessary to understand that social bonds can be permeated by a "diagnostic labeling", and that medical-psychiatric discourse has gone a long way, so it involves public policies on mental health, its actors and society as a whole. It is a matter of rethinking such policies and reflecting on the effects that are caused in the subject by virtue of the hegemony of the medical-psychiatric discourse and normalization through the medicalization of the symptoms. Likewise, it is a question of rethinking the influence of the normative action of psychiatric knowledge on society and on the conception of madness and in what way this contributes to the maintenance and even aggravation of the vulnerability of people with mental suffering through of the analysis of discursive cuts obtained in nine interviews with the servers and users of the substitutive services of mental health in Araguaína-TO. In this context, we used the content analysis method, which allowed us to glimpse the return of traditional psychiatry thinking and actions without the status of paradigm break through the psychiatric reform, in addition to the anti-asylum fight. The categorical interpretations revealed the exclusion of the subject's view of desire, subject of the unconscious before the therapeutic process, society and life and the weakening of citizenship, indispensable for a better elaboration of the subject about himself and his condition of life.