Há uma porta do manicômio que só abre pelo lado de dentro: a clínica psicanalítica das psicoses desencadeadas na instituição total

Abstract

The present thesis is the result of a research carried out at unit I of CIAPS Adauto Botelho, the only public psychiatric hospital in the State of Mato Grosso. The psychiatric hospital is a whole institution, having a rigid and inhospitable functioning to any possibility of incidence of the subject of the unconscious. Starting from the methodological path made possible by psychoanalysis, the idea of establishing a psychoanalytic clinic in this institution was set. Since this is a research with a clinical and political outlook, the history of madness was initially revisited, starting from the ‘invention’ of internment to the present day, marking similarities and differences in those times. On Brazilian history, the Brazilian Psychiatric Reform (RPB) and its developments, advances, setbacks and threat of extinction are retaken. The history of the institutionalization of mental health in Mato Grosso is told from the case of Noemia, institutionalized for twenty-two years in the psychiatric hospital. Her case, unfortunately, highlights all possible errors in the absence of an articulated network, as well as showing how much it is possible for schizophrenia to benefit from psychoanalysis. The theory of psychoses is approached starting from Freud going to Lacan. We verify that psychoses have an important part in the advances of Psychoanalysis since Freud. We present Lacan's formulations about the structural conditions for the triggering of psychosis and its possibilities for stabilization, we resort psychoanalysts from our advanced times in the clinic of psychoses to outline their own way of functioning. To think about a non-asylum clinical direction in a closed institution, we looked for the work carried out by Jean Oury in a psychiatric clinic, whose operation he called “collective”, managing to include the singularities, keep them in circulation, without absorbing them through institutional inertia. As much as our Brazilian and Mato Grosso´s realities are very different from a French psychiatric hospital, nothing prevents their work from inspiring us and, perhaps, making us decide on a new way of treating those who suffer excessively. The fragments of clinical cases attended before and during the research were our guides to the elaborations, which did not occur without the impasses of the psychoanalytic clinic at the psychiatric hospital. We approached the theory of clinical psychoses and the ways of dealing with transference management in triggered psychoses, some collected from renowned authors of psychoanalysis, others invented in view of the impasses of emerging situations. We support that psychoanalysis is unconditionally anti-asylum: the presence of the analyst in action and word permits a direction of treatment for serious cases that reach closed services, favoring the incidence of the subject of the unconscious and the establishment of transference ties that support a work with triggered psychoses that dispense with secular forms of control over madness. The old distinction between locking or treating, which always seems so obvious to us, may not be so easily placed, as it is an act decided to always be replaced, whether in hospitals or any other device on the network.