A trajetória das políticas de saúde mental e de álcool e outras drogas no século XX / The trajectory of mental health policies and alcoholand other drugs in the twentieth century

Resumo Este artigo tem por objetivo analisar a evolução temporal das regras que compõem o arcabouço legal das políticas públicas de saúde mental e de álcool e outras drogas entre os anos de 1900 até 2000. O estudo busca analisar a trajetória das regras, de modo que se possa compreender um pouco mais sobre o contexto e a forma no qual as questões relacionadas a estes dois temas foram tratados, até a Reforma Psiquiátrica no Brasil, em 2001. Para isso realizou-se uma pesquisa documental e bibliográfica, com o intuito de avançar no entendimento destas duas políticas sobre um ângulo mais normativo. Em um emaranhado de legislações, foram catalogadas 33 normas que, após análise, demonstram o processo de construção das políticas públicas relacionadas ao uso de álcool e outras drogas, alterando a lógica repressiva da justiça e da patologização do uso de drogas e possibilitando a transição da discussão do terreno da segurança para o da saúde pública, mais especificamente de saúde mental.

Abstract The scope of this article is to analyze the temporal evolution of the rules that comprise the legal framework of public policies on mental health and on alcohol and other drugs between the years 1900 to 2000. The study seeks to analyze the trajectory of the rules to make it possible to understand a little more about the context and the way in which the issues related to these two themes were addressed prior to the Psychiatric Reform in Brazil, in 2001. For this purpose, documentary and bibliographical research was conducted, with the intention of enhancing the understanding of these two policies from a more normative angle. In the skein of legislation, 33 norms were cataloged which, after analysis, reveal the process of construction of the public policies related to the use of alcohol and other drugs, changing the repressive logic of justice and the "pathologization" of drug use and enabling the transition of the discussion from the field of security to that of public health, more specifically of mental health.

Award for Distinguished Scientific Early Career Contributions: Lara A. Ray.

The APA Awards for Distinguished Scientific Early Career Contributions to Psychology recognize psychologists who have demonstrated excellence early in their careers and have held a doctoral degree for no more than 9 years. One of the 2017 award winners is Lara A. Ray, for "her substantive and innovative research on mechanisms that underlie alcohol and tobacco use disorders and for leveraging that knowledge to develop new, personalized treatment approaches for these disorders." Ray's award citation, biography, and a selected bibliography are presented here. (PsycINFO Database Record

Scott Fitzgerald: famous writer, alcoholism and probable epilepsy / Scott Fitzgerald: famoso escritor, alcoolismo e provável epilepsia

ABSTRACT Scott Fitzgerald, a world-renowned American writer, suffered from various health problems, particularly alcohol dependence, and died suddenly at the age of 44. According to descriptions in A Moveable Feast, by Ernest Hemingway, Fitzgerald had episodes resembling complex partial seizures, raising the possibility of temporal lobe epilepsy.

RESUMO Scott Fitzgerald, reconhecido escritor americano, mundialmente famoso, apresentou vários problemas de saúde, particularmente a sua dependência ao álcool, tendo morte súbita aos 44 anos de idade. Relatos publicados no livro de Ernest Hemingway “Paris é uma festa” dão conta de que Scott Fitzgerald apresenta prováveis crises parciais complexas, sugerindo a hipótese de epilepsia do lobo temporal.

Comunidades terapêuticas: "novas" perspectivas e propostas higienistas / Therapeutic communities: "new" outlooks and public health proposals

Resumo Problemas decorrentes do uso/abuso de álcool e outras drogas agravam-se continuamente. Existem, atualmente, medidas polêmicas que visam a soluções imediatas, como o financiamento público das comunidades terapêuticas. Analisam-se, aqui, possíveis aproximações do legado higienista do início do século XX em questões que envolvem o uso/abuso de substâncias psicoativas com as propostas de intervenção das comunidades terapêuticas atuais. Realizou-se pesquisa com fontes primárias, inspirada na vertente do materialismo histórico. Entende-se que os problemas decorrentes do uso/abuso de drogas continuam deixando o ônus maior aos usuários, às pessoas ao redor e à saúde pública.

Abstract Problems related to alcohol and other substance abuse are on a steady rise. Certain controversial measures currently aim at immediate solutions, such as the public funding of therapeutic communities. The article draws comparisons between the legacy of early twentieth-century public health practices in psychoactive substance abuse and current proposals for intervention through therapeutic communities. The study researched primary sources from the perspective of historical materialism. Historically produced by society as a whole, problems stemming from substance abuse continue to place the greatest burden on users, the people around them, and public health.

Alcoolismo e estética da existência: Jack London e a lógica branca de John Barleycorn / Alcoholism and the aesthetics of existence: Jack London and the white logic of John Barleycorn

Elaborada durante as discussões da Lei Seca e o Sufrágio Universal nos EUA, no início do século XX - duas emendas que seriam aprovadas no sistema constitucional americano -, Memórias alcoólicas, do escritor norteamericano Jack London, é considerada uma obra referencial sobre o tema do alcoolismo. Tendo esse tema como fio condutor, o artigo analisa como a sua prosa se constitui em prática de si enquanto construção de subjetividade e organização da existência. Investiga como essa obra estabelece relações com a temática do cuidado de si, problematizada por Michel Foucault nos volumes 2 e 3 da História da sexualidade, acerca da estética da existência e das artes de viver presentes no universo social greco-romano e helenístico.

Employing this theme as a guideline, this article examines how his prose amounts to self-practice in the construction of subjectivity and the organization of existence. It investigates how this work is related to the theme of self-care, analyzed by Michel Foucault in volumes 2 and 3 of the History of sexuality, as regards the aesthetics of existence and the art of living which existed in the Greco-Roman and Hellenistic worlds.

Grupo focal como estratégia para a prevenção da recaída no alcoolismo / Focus group as a strategy for the prevention of alcoholism relapse / Grupo focal como estrategia para la prevención de la recaída en el alcoholismo

O objeto deste estudo foram os agravos à saúde identificados pelo grupo focal como motivo para a prevenção da recaída no alcoolismo. Os objetivos foram analisar as sequelas ou agravos à saúde que levam à prevenção da recaídano alcoolismo. Trata-se de um estudo descritivo, com uso de grupo focal. Os sujeitos foram 31 clientes, entre 18 e 65 anos, atendidos pela Secretaria Municipal de Saúde e Defesa Civil-RJ e Centro de Estudos, Pesquisa e Referência em Alcoologia e Adictologia, entre julho a setembro de 2009. Um total de 38% respondeu que os motivos que levam o alcoolista à prevenção da recaída foram: tuberculose, hipertensão arterial, Diabetes Mellitus, problemas cardiovasculares e psiquiátricos. A partirdos resultados, conclui-se que são necessárias a aplicação da redução de danos e agravos à saúde e o incentivo à realização de tratamento especializado.

This study is concerned with health problems identified by the focus group as causes for the prevention of alcoholism relapse. It aimed at analyzing sequels or health problems leading to the prevention of alcoholism relapse. This is a descriptive study, using focus group. Subjects were 31 clients aged from 18 to 65, assisted by the City Department of Health and Civil Defense-RJ and Center for Studies, Research and Reference on Alcoholism and Addiction, from July to September,2009. Thirty-eight per cent (38%) of respondents identified the following reasons why alcoholics seek relapse prevention: tuberculosis, hypertension, Diabetes Mellitus, cardiovascular, and psychiatric problems. Results indicate reduction of health harm and health problems levels as well as the fostering of specialized treatment are required.

El objeto de este estudio fueron los problemas de salud identificados por el grupo focal como razón para la prevención de recaídas en el alcoholismo. Los objetivos fueron analizar las consecuencias o problemas de salud que conducen a la prevención de recaídas en el alcoholismo. Se trata de un estudio descriptivo, mediante grupo focal. Los sujetos fueron 31personas de 18 a 65 años, atendidas por la Secretaría Municipal de Salud y Defensa Civil-RJ – Brasil y el Centro de Estudios, Investigación y Referencia sobre Alcoholismo y Adictologia, entre julio y septiembre de 2009. Un total de 38% respondió que las razones que llevan los alcohólicos para la prevención de recaídas fueron: tuberculosis, hipertensión, Diabetes Mellitus, problemas cardiovasculares y psiquiátricos. De los resultados, se concluye que son necesarios la aplicación de la reducción de daños y problemas de salud y el fomento de un tratamiento especializado.

Processos de alcoolização indígena no Brasil: perspectivas plurais / Indigenous drinking processes in Brazil: plural perspectives

Quais são os critérios para identificar quando o consumo de bebidas alcoólicas se tornou problemático? Os critérios biomédicos que definem a dependência ao álcool como uma patologia se aplicam a todos os contextos culturais? O uso do álcool é uma questão de contornos complexos, em especial quando se consideram os povos indígenas, entre os quais problemas relacionados ao uso de álcool aparecem como importantes problemas de saúde pública, embora a produção acadêmica nacional sobre o assunto ainda seja relativamente escassa. Como o álcool adquire uma variedade de funções em diferentes grupos sociais, a análise não pode se restringir à ingestão da bebida em si: é preciso relacionar o consumo a processos socioculturais e político-econômicos. É o que defendem os autores desta coletânea, que descreve e analisa as características específicas dos diversos modos de uso de álcool em diferentes povos indígenas brasileiros. Os capítulos trazem relatos teóricos, etnográficos, historiográficos e de intervenções culturalmente orientadas. Buscam superar os enfoques limitados aos aspectos patológicos do consumo de álcool: demonstram que os efeitos da bebida – sejam negativos, sejam positivos – não podem ser dissociados de seus aspectos sociais, econômicos e psicológicos. Essa complexidade aponta para a necessária complementaridade entre as perspectivas da biomedicina e as das ciências sociais, além de ratificar a importância do protagonismo indígena no enfrentamento dos problemas relacionados ao uso de bebidas alcoólicas

Nutritional cerebellar degeneration, with comments on its relationship to Wernicke disease and alcoholism.

Nutritional cerebellar degeneration occurs in alcoholism and other states that predispose to malnutrition, such as gastric bypass surgery. Gait ataxia is the principal clinical manifestation. Ataxia of the lower limbs is not uncommon, but upper extremity ataxia and nystagmus are rare. Atrophy of the anterior superior vermis is the primary pathological manifestation in established disease. Typically, the onset is subacute. This cerebellar disease is part of the spectrum of the Wernicke-Korsakoff syndrome, i.e. the cerebellar manifestation of Wernicke disease. It may occur with other lesions of Wernicke disease or in isolation. Rarely, with florid disease, lesions may be hemorrhagic. Active disease should be treated with thiamine in the same way that one treats Wernicke disease. Clinicopathologic correlation in this disease has provided the best evidence that the anterior superior vermis is important in coordinating bipedal locomotion.

Robert Garrett, Tasmanian penal colony surgeon: alcoholism, medical misadventure and the penal colony of Sarah Island.

Robert Garrett emigrated from Scotland to Van Diemen's Land (now Tasmania) in 1822. Within a few months of arrival he was posted to the barbaric penal colony in Macquarie Harbour, known as Sarah Island. His descent into alcoholism, medical misadventure and premature death were related to his largely unsupported professional environment and were, in many respects, typical of those subjected to this experience.

Alcoolismo e medicina psiquiátrica no Brasil do início do século XX / Alcoholism and psychiatric medicine in early twentieth-century Brazil

Aborda o desenvolvimento da psiquiatria no Brasil, entre o final do século XIX e as três primeiras décadas do XX, com base no estudo da construção de saberes e práticas, neste campo, acerca do alcoolismo. Discute a visão da psiquiatria sobre a responsabilidade do álcool na manifestação da loucura. Trata a hipótese de que o conceito de 'psicose alcoólica' buscou enfeixar os sintomas e problemas causados no indivíduo pelo alcoolismo crônico. Chama atenção para o fato de que esta era uma 'doença social', definição que a aproxima das classes populares: de seus costumes, práticas e condições de vida. Procura analisar as internações nos hospícios, recuperando os ecos das discussões médicas e tomando as reflexões do escritor Lima Barreto como contraponto ao saber médico da época.

Socio-political implications of the fight against alcoholism and tuberculosis in Colombia, 1910-1925 / Luchando por la patria, forjando trabajadores: tuberculosis, alcoholismo y salud pública en Colombia, 1910-1925

The emergence of a modern state in Colombia and the centralization of political and administrative power in Bogotá began to take shape during the latter decades of the nineteenth century. The state had a central role within the overarching modernisation discourse that sought to create a common national identity. One of the tasks assigned to the state by the national project was that of implementing policy for regulating public health and strengthening social control institutions. Such objectives should be analyzed as part of larger political centralization processes and the desire to create "ideal" citizens. Public health and sanitary campaigns implemented by government officials during this period targeted vice, immorality, illness and ignorance under the umbrella of social reform programmes. Government officials, hygienists and medical doctors continually placed emphasis on eradicating or regulating alcoholism and tuberculosis from 1910 to 1925, with the hopes of avoiding a national crisis. This paper examines how alcoholism and tuberculosis became central themes in the fears expressed by Colombia's ruling class at the time regarding the broader social decay of the nation. As intellectuals and public officials sought solutions to these ills, their explanations alluded to the disintegration of morality and values and the degenerative effects of vice, addiction and unsanitary conditions.

En Colombia, el surgimiento de un Estado moderno y la centralización del poder político y administrativo en Bogotá comenzaron durante las últimas décadas del Siglo XIX. Dentro de un discurso de modernidad que buscó la consolidación de una identidad nacional, el Estado jugó un importante papel. Dentro de las tareas asignadas al Estado moderno se encontraban políticas de salud pública y control social. Estas políticas deben ser analizadas como parte de una ola centralizadora y la necesidad de forjar ciudadanos sanos. Las campañas de salubridad buscaban erradicar el vicio, la inmoralidad, la enfermedad y la ignorancia bajo el manto de reformas sociales. De 1910 a 1925, médicos, higienistas y políticos se enfocaron en la erradicación del alcoholismo y la tuberculosis, con la intención de evitar una crisis nacional. Este trabajo explora como el alcoholismo y la tuberculosis se convirtieron en temas recurrentes en el discurso medico de principios de siglo, el cual enmarcaba a estas dos enfermedades como símbolos de la decadencia social y moral del pueblo colombiano.

Campañas de salud y educación higiénica en México, 1925-1960: del papel a la pantalla grande / Health campaigns and hygienic education in Mexico, 1925-1960: from the paper to the great screen

Una de las grandes preocupaciones de los gobiernos posrevolucionarios fue ofrecer servicios de salud y crear una cultura de la higiene en todos los mexicanos. Para alcanzar este objetivo, además de fomentar la formación de personal médico, apoyar la investigación científica, construir clínicas y hospitales, a partir de 1925 se implementaron ambiciosas campañas de salud y programas de educación higiénica para combatir epidemias y enseñar a la población a evitar enfermedades a través de la prevención, la vacunación y la asimilación de desejos sobre higiene. Para que estos programas llegasen a la población, se diseño, produjo y dinfundió propaganda de manera oral, escrita, visual y audiovisual; es decir, a través de conferencias, programas radiofónicos, folletos, carteles, exposiciones y cine. Los programas de educación higiénica y su propaganda ha sido un tema poco analizado por los historiadores de salud pública cuyo interés se ha enfocado en la historia de médicos e instituciones, la organización propia de cada campaña sanitaria, su puesta en marcha en las comunidades y algunas manifestaciones de resistencia de la población hacía las medidas sanitarias que consideraron impositivas y/o riesgosas. Por esta razón, nuestra mirada analítica se centrará en cuatro grandes iniciativas realizadas entre 1925 y 1960 caracterizadas por su profusa producción propagandística: la Campaña Nacional contra las Enfermedades Venéreas (1927), la Campañas Nacional contra el Alcoholismo (1929), Salud para las Américas (1943-1950), y la Campaña Nacional de Erradicación del Paludismo iniciada en 1957. Estas campañas utilizaron el cine como un novedoso instrumento de educación higiénica, fomentando la exhibibión de películas estadounidenses e incentivando la producción nacional.

The problems of alcohol and cigarette abuse: BJN 100 years ago.

The causation of inebriety or drunkenness was thought to be caused by two factors, according to Dr Harry Campbell (a former president of the Society for the Study of Inebriety): low resistance power to the allurement of alcohol and abundant access to alcoholic liquors.

Alcoholismo y cambio social: un programa de Salud Mental Comunitaria en el área sur de Santiago [1968-1973] / Alcoholism and social change: a program of Communitarian Mental Health in the South area of Santiago [1968-1973]

Presenta una abordagen sobre la psiquiatría intracomunitaria de Juan Marconi. El cambio fue uno de los proyectos discutidos e implementados para combatir el flagelo, que recogió el desafío de la masificación de los servicios de salud con una propuesta de bajo costo y en consonancia con el discurso público de la participación social. El 1 de octubre de 1968 se inauguró el primer programa intracomunitario de alcoholismo en el Policlínico Santa Anselma, unbicado enre los paraderos 211-212 de Gran Avenida. A cargo del psiquiatra Juan Marconi, la iniciativa se instaló en el área sur de Santiago, que, con un total de 800.000 habitantes, comprendía las comunas de San Miguel, La Cisterna, San Bernado y Calera de Tango.

[Social diseases in the interwar period in the Lwów Province]. / Choroby spoleczne w okresie miedzywojennym w województwie lwowskim.

The health state of Polish society in the interwar period was unsatisfactory. In particular, the danger was posed by social diseases, understood to be serious diseases of prolonged type, widespread among people. The diseases included: tuberculosis, trachoma, venereal diseases, infancy diseases causing a large scale infant mortality, excessive mortality among mothers in the peripartum (around birth) period, alcoholism, mental diseases, goiter, cancers, and occupational diseases. Because of the character of the social diseases, fighting them was long, and the interactions aimed not only at the ill ones, but also at their environment. The main role in this process was played by social ambulatories, whose chief task was prophylaxis. The actions differed depending on individual diseases. The personnel consisted of doctors, social nurses, school hygienists, sanitary supervisors, and social keepers. There were undertaken coordinated actions, supported by the state, provincial and district self-governments, and social organizations. Regulations governing the fight against social diseases were created. They mainly applied to organizing institutions and obligatory registration of diseases. Thanks to cyclically growing number of institutions, personnel trainings and sanctioning of the fight against social diseases, the epidemiologic situation improved noticeably towards the end of the period.

El alcoholismo: reflexiones sobre tres décadas de investigaciones en el Hospital Psiquiátrico de La Habana / Alcoholism: considerations about three decades of researches in the Psychiatric Hospital of Havana

Luego de algunas consideraciones sobre la problemática mundial de las drogas y de considerar el alcoholismo como la adicción modelo y portera, el autor reflexiona sobre los resultados de las investigaciones desarrolladas por su equipo durante las tres últimas décadas en el Hospital Psiquiátrico de La Habana, centro referencial cubano para la atención de esta y otras drogadicciones. Comenta los hallazgos más relevantes de las tres líneas de investigación de la institución orientadas a: caracterización clínica, validación de instrumentos diagnósticos y valoración de recursos terapéuticos. Asimismo describe en forma sintética algunas especificidades clínico-epidemiológicas de dicha afección en los pacientes atendidos, así como los esquemas terapéuticos que imbrican los criterios internacionales con las particularidades del contexto etnosociocultural e histórico cubano.

After some considerations about the global problem of drugs consumption and considering alcoholism as the gateway and model addiction the author think about the results of the developed researches done by his team during the last three decades in the Psychiatric Hospital of Havana; Cuban center of reference for the care of alcoholism and other addictions. The author comments about the most relevant findings of the three lines of investigation of the institution directed to: clinical characterization, validation of diagnostic instruments and assessment of therapeutical resources. He also describes in a brief way some clinical-epidemiologic specificities of this affection in patients treated and therapeautical schemes that overlap the international criteria with the peculiarities of the Cuban historical and etnosocio-cultural context.

A sober Reich? Alcohol and tobacco use in Nazi Germany.

Alcohol and tobacco use did not fit well with National Socialist aesthetics. However, these substances were not proscribed in Nazi Germany in spite of the heavy penalties for excessive use: Alcoholics were sterilized, and smoking by children was a criminal offense. This article argues that the great demand of the German people for these products prevented the authoritarian regime from alcohol and tobacco prohibition but measures were taken by the Nazis to reduce tobacco and alcohol consumption in the next generation.

Taking biology seriously: the next task for historians of addiction?

Despite more than a century of attempts to control the use of addictive substances, prevalence rates continue to grow for most of them. Exceptions are tobacco and alcohol use, which, nevertheless, remain major public health concerns. Why have these attempts at drug control had little success? This question is addressed in the histories of substance use that are examined in this essay. While these studies show that there are multiple histories, definitions, and frames of addiction that have shifted over time, some broad themes emerge. Foremost is the argument that the classification of a substance as licit or illicit has had more to do with cultural values than with the substance itself. Historians, skeptical of essentialist categories, have questioned whether addictions are diseases and the wisdom of selectively criminalizing drug use. They argue that the socioeconomic status of users has influenced attitudes toward addicts and the legal classifications of substances.