Uma perspectiva multinível e plural em psiquiatria: a esquizofrenia como exemplar

Abstract

Just as medicine, psychiatry does not consist in a theoretical discipline, but in praxis, a theoretical project that is only justified by practical project. Therefore, it is a field of intervention. Psychiatry uses various theoretical and scientific approaches with a practical purpose. However, the subject of this field cannot to be confused with the subject of these approaches. The subject of psychiatry can be defined in reductionist and non-reductionist strands. In the current context, there is a tendency to polarization. On the one hand, the subject of psychiatry is conceived as the subject of other medical specialities, as a mental disease, located in the brain and resulting in practices that favor biological approaches. On the other hand, in broader strands of definition, it consists on psychic and social suffering or socially inappropriate internal dysfunctions, which involves multiple levels and dimensions - biological, phenomenological, cultural. This conception of the subject of psychiatry demands a multiplicity and plurality of approaches in both theoretical and practical plans. This thesis affirms that a multilevel and plural perspective is imperative to psychiatric praxis. The thesis is divided into two parts. In the first part, there is a philosophical discussion in psychiatry, by the method of conceptual investigation, aiming a theoretical refinement of the field, which tends to generate more effective practices. Three philosophical problems that pass through psychiatry are discussed: the explanation-understanding distinction, the mind-brain problem and the fact-value distinction. A pragmatist solution for each of these problems is pointed. In the second part, there is a case study of schizophrenia as exemplar, analyzing the multiple levels of the phenomenon upon presentation of biological, phenomenological and anthropological approaches to schizophrenia in contemporary times. This case study is focusing on neurodevelopmental hypothesis, changes in pre-reflective self-consciousness and conceptions of the phenomenon in non-Western contexts, respectively. Schizophrenia represents a category of high validity, with an important contribution of genetic-biological factors. Still, the biomedical model is insufficient to account for the complexity of the experience of suffering this condition. Therefore, a multilevel and plural perspective becomes mandatory. And if this perspective applies to schizophrenia, also will apply to all mental disorders, with important implications for psychiatric praxis, either within the theory and research, either within the clinical and mental health policy development, adjusting better, for example, to the purposes of the Global Mental Health.