Psicanálise e saúde mental: contextualizando o atendimento às demandas / Psychoanalysis and mental health: Contextualizing the demands for care / Psychanalyse et santé mentale: contextualisation de l´accueil des demandes / Psicoanálisis y salud mental: contextualizando la atención a las demandas

No Brasil, o campo da saúde mental constitui-se a partir de política pública que direciona o funcionamento de seus serviços segundo uma lógica de tratamento distinta da manicomial. Partindo das premissas da reforma psiquiátrica, o atendimento nesse campo deve ser de base comunitária e implicar vários profissionais. Nesse contexto, nas respostas às demandas de atendimento os profissionais devem respeitar as diretrizes do SUS e da política pública de saúde mental brasileira, assim como a particularidade de cada caso. Ao mesmo tempo, é livre para trabalhar de acordo com a abordagem teórico-metodológica de sua escolha. Neste artigo, a partir de dados clínicos referidos a uma prática em saúde mental, explicitamos a especificidade da orientação da psicanálise como base para a construção de encaminhamentos possíveis.

In Brazil, the field of mental health is constituted by public policies that guide the operation of its services according to a treatment logic that is different from the asylum. Starting from the premises of the psychiatric reform, the service in this field should be community-based and should involve several professionals. In this context, in the responses to the demands for care, professionals must respect the guidelines of the Unified Health System and of the Brazilian mental health public policy, as well as the particularities of each case. At the same time, they are free to work according to the theoretical and methodological approach of their choice. In this article, from clinical data related to practice in mental health, we highlight the specific orientation of psychoanalysis as a basis for the construction of possible follow-ups.

Au Brésil, le champ de la santé mentale se structure à partir d´une politique publique qui organise le fonctionnement des services selon une logique de traitement contraire à celle de l´asile d´aliénés. Partant des prémisses de la réforme psychiatrique, le traitement doit être communautaire et impliquer différents professionnels. Dans ce contexte, les réponses des professionnels doivent respecter les directives du SUS et de la politique publique de santé mentale brésilienne, ainsi que la particularité de chaque cas. Mais dans le même temps, les professionnels sont libres de travailler en accord avec leur choix théorico-méthodololique. Dans cet article, à partir des données cliniques extraites d´une pratique en santé mentale, nous explicitons la spécificité de l´orientation de la psychanalyse comme base pour de possibles prises en charge.

En Brasil, el campo de la salud mental se constituye a partir de la política pública que dirige el funcionamiento de sus servicios de acuerdo a una lógica de tratamiento distinta de la de manicomio. A partir de las premisas de la reforma psiquiátrica, la asistencia en este campo se basa en la comunidad e involucra a varios profesionales. En este contexto, en las respuestas a las demandas de atención, los profesionales deben respetar las orientaciones del Sistema Único de Salud (SUS) y de la política pública de salud mental brasileña, así como también la particularidad de cada caso. Al mismo tiempo, es libre para trabajar según el enfoque teórico-metodológico de su elección. En este artículo, a partir de los datos clínicos referidos a una práctica en salud mental, hemos explicitado la orientación específica del psicoanálisis como base para la construcción de posibles encaminamientos.

Succeeding at succession: the myth of Orestes.

Although the myth of Oedipus seems an inevitable template for understanding succession in psychoanalysis, the myth of Orestes offers a more complex and promising view of the intergenerational transfer of leadership and authority, one that takes into account the entire community, not merely the individual leader. A closer look at the Aeschylus drama suggests three dimensions that need to be taken into account in managing succession: what are the mechanisms enabling the community to participate, what is the role of the unconscious irrational forces inevitably aroused in the process, and what are the wider social and economic issues that need to be addressed? This paper looks at the myth elaborated in the Greek drama, and then applies it to some of the current problems facing contemporary psychoanalytic institutions.

Making the case for psychoanalytic therapies in the current psychiatric environment.

A variety of political, economic, and scientific forces have caused psychoanalytic therapies to become marginalized in psychiatry. These therapies are given short shrift in recently developed treatment guidelines, which are based largely on notions of empirical validation narrowly construed. Questions about the efficacy of psychoanalytic therapy can be meaningfully addressed by systematic assessment of available knowledge and potential data bases and by explicit efforts to locate the role of psychoanalytic therapies alongside other modalities. Several steps that might lend the psychoanalytic therapies greater credibility are proposed: (1) define the distinguishing features; (2) identify clear indications and contraindications; (3) systematically collect case histories of successfully treated mentally ill (diagnosable) patients; (4) increase vigilance (together with the patient) toward assessing progress in treatment.