Entre ações e reações: controvérsias em torno da recusa aos psicofármacos na atenção psicossocial

Abstract

The purpose of this dissertation is to discuss the refusal of psychotropic drugs within the scope of psychosocial care. Considered by some to be one of the most controversial rights in the ethical panorama of mental health care, the refusal to take medication tends to mobilize various implications within clinical settings. Here it is used as an analytical operator focused on health services and practices, starting from the agencies not only of the subjects, but also of the medicines themselves, as non-human actors. The text is divided into a bibliographic tour on the subject and the consequences of a field study carried out in a Psychosocial Care Center - CAPS III in the city of Rio de Janeiro, where we sought to access the report of professionals about the management of the refusal to psychotropic drugs in everyday care. The material collected from semi-structured interviews carried out remotely with 10 (ten) professionals from this service was submitted to a narrative analysis and used as a guideline for the discussion. A longer look at this phenomenon revealed its ethical and political scope, allowing the elaboration of questions about the role of psychotropic drugs and autonomy within the Brazilian Psychiatric Reform and contemporary culture. Through a dynamic twist between the right of refusal and the right of access, it became possible to explore different reactions mutually produced among the actors in the field. In this context, in which some shortages and excesses were present, the limits in the encounter with the different crisis scenarios highlighted certain interfaces on drug uses and the implications of their refusal. The work seeks to contribute to the mapping of this controversy within the Brazilian conjuncture through an outline of locally situated aspects in contrast to other realities in which this debate has received more attention.