Um estudo histórico e conceitual sobre a clínica da reforma psiquiátrica brasileira

Abstract

An Historical and Conceptual Study on the Clinic of Brazilian Psychiatric Reform. This work argues the historical and conceptual foundations of the brazilian psychiatric reform. The main matter that is placed is how to accomplish the transformation of the assistance in mental health without resorting to psychiatric, psychoanalytical or cultural reductionist theories, but pointing to a clinical pluralism. To answer this matter we study authors who did an epistemological approach of the psychiatry constitution placing in debate two central ideas. The first idea is defended by Foucault who considers the invention of the psychiatry and his object, the mental disease, an undesirable reduction of the madness whose consequence is his exclusion of the world. The second idea defended by Gauchet and Swain is opposed to the previous and search to show that the psychiatry was an advance in the understanding of a complex phenomenon. However, the model of care promoted by the psychiatry based on insane asylum failed when not offered therapeutic effectiveness and social inclusion for a lot of patients. In consequence of this process have been initiated actions of psychiatric reform in the largest part of the world. Pioneering experiences were able to formulate new treatments in which psychoanalytical, phenomenological and sociological theories had an important role. Based in these experiences were formulated public politics in mental health that tried to conciliate the treatment with not exclusion. We examine, from there onwards, the reform main experiences, the current state and their influences in Brazil. We analyze the brazilian psychiatric reform and the criticisms that are done about it. Soon, we try to understand the theoretical bases of the reformist experience in the country. We describe three thought slopes that based the actions of the new services created by the psychiatric reform. These slopes, although in any aspects overlay, in other antagonize frontally. They are the basaglian, lacanian and pluralistic perspectives. Aiming base this last perspective, we argue authors who work in the interface of the psychiatry with pragmatic philosophy and we also approach this conception of the thought with the psychoanalyst Donald Winnicott as a contribution to the clinic of the reform. The work considers the possibility to board a psychiatric reform from the point of view of a plural clinic that authorizes incorporation of other theoretical references and that serve as instruments of reflection and practice action for the conduction of complex and multifaceted clinical situations.