Ley 21331: nuevos desafíos de la Ley del reconocimiento y protección de los derechos de las personas en la atención de salud mental / Law 21331: new challenges of the law of recognition and protection of people's rights in mental health care

Since the dawn of the Republic, the question regarding the diagnosis, management and treatment of mental illnesses has been an unresolved issue to this day. Since before the time of the colony, at the time of the conquest, mental illnesses abounded, both in the Mapuche population - autochthonous indigenous - and in the Spanish. The presence in the river basins of heavy metals and minerals toxic for human consumption, as was originally the Mapocho River, whose waters were not drinkable and were only used for crops adopted from the Inca culture, were consumed by the population of the Spanish conquerors, who manifested various types of mental disorders, either due to the consumption of polluted water and the neurological damage that it caused them, the high levels of stress due to the same occupation and the isolation in which they found themselves and the diseases venereal that they carried, which they progressively transmitted to the aboriginal population. (1) On the other hand, the Mapuche population had magical-ritual treatments and methods to treat these and other diseases based on herbalism, phytotherapy and rituals (2) for the evil of melancholy (depression), anxiety disorders, panic attacks and schizophrenia. (3) Centuries later, when medicine and hard science are presented in society giving way to the scientific method, key people make their appearance within mental health studies, who made their way into the national and world panorama, and who, despite the dark past and the tortuous evolution of this branch of medicine, stand out figures who were pioneers and who gave rise to a reality that today continues in constant development and debate. Today mental health is an issue on the table, and Law 21331, promulgated on April 23, 2021 (4) is a response to changes in the perception that society currently has of the concept of disease, which is contrasted to the thinking and management that existed for years, decades and centuries ago around mental health

Desde los albores de la República, la cuestión referente al diagnóstico, manejo y tratamiento de las enfermedades mentales ha sido un tema sin resolver hasta nuestros días. Desde antes del tiempo de la colonia, en la época de la conquista, las enfermedades mentales abundaban, tanto en la población mapuche -indígena autóctona- como en la española. La presencia en las cuencas fluviales de metales pesados y minerales tóxicos para el consumo humano, como fue en su origen el río Mapocho, cuyas aguas no eran bebestibles y solo se utilizaban para los cultivos adoptados de la cultura inca, fueron consumidas por la población de los conquistadores españoles, los cuales manifestaron diversos tipos de trastornos mentales, ya fuese por el consumo de aguas contaminadas y el daño neurológico que les provocaba, los altos niveles de estrés debido a la misma ocupación y al aislamiento en el que se encontraban y las enfermedades venéreas que portaban, las cuales transmitieron progresivamente a la población aborigen. (1) Por otra parte, la población mapuche tenía tratamientos y métodos mágico-rituales para tratar estas y otras enfermedades basados en la herbolaria, la fitoterapia y los rituales (2) para el mal de la melancolía (depresión), trastornos ansiosos, crisis de pánico y la esquizofrenia.(3) Siglos más tarde, cuando la medicina y la ciencia dura se presentan en sociedad dando paso al método científico, hacen su aparición personas clave dentro de los estudios en salud mental, quienes se abrieron camino dentro del panorama nacional y mundial, y que, pese al pasado oscuro y a la evolución tortuosa de esta rama de la medicina, se destacan figuras que fueron pioneras y que dieron pie a una realidad que hoy en día continúa en constante desarrollo y debate. Hoy la salud mental es un tema sobre la mesa, y la Ley 21331, promulgada el 23 de abril del año 2021 (4) es una respuesta a los cambios en la percepción que la sociedad actualmente tiene frente al concepto de enfermedad, que se contrasta al pensamiento y manejo que durante años, décadas y siglos atrás existió en torno a la salud mental

Could Carmelite Spirituality Promote Good Mental Health? A brief Tribute to Saint Teresa of Avila in the 500th anniversary of her birth.

Often it is overlooked that Christian Spirituality involves a personal relationship of a human being with God. It is of interest that both the Protestant Reformers and the exponents of the Catholic Counter Reformation agreed upon this. Two of the greatest exponents of the Counter-Reformation, both of whom were made Doctors of the Church because of their teaching on Prayer were Saint Teresa of Avila and Saint John of the Cross. This year is the 500th anniversary of the birth of Saint Teresa of Avila. Here, as a Catholic Psychiatrist, I argue that the teaching of both saints about the prayer life, properly understood, tends to improve self worth, and therefore must tend to help persons with mental health problems.

Improving mental and physical health outcomes in general healthcare settings: a Gedenkschrift in honor of Wayne Katon, MD (1950-2015).

This special article pays tribute to Wayne Katon, MD (1950-2015) with a Gedenkschrift, or review, of his prolific academic career. Abstracts of all of Dr. Katon's Medline citations were reviewed to develop a narrative of his seminal epidemiological and interventional research findings. Specifically, we describe: (a) how Dr. Katon's clinical work and observational epidemiology and health services research informed and guided interventional studies; (b) the evolution of multidisciplinary interventional trials from primary care-based psychiatric consultation to primary care-based collaborative care for depression to multicondition collaborative care; and (c) how Dr. Katon's research has informed the work of other leading researchers in the field of psychosomatic medicine and helped develop a new generation of researchers at the interface of psychiatry and primary care. For more than three decades, Dr. Katon led a multidisciplinary research team that conducted seminal epidemiological studies and randomized trials and that influenced the thinking and research in the field of psychiatry in a number of areas: (a) the importance and impact of mental disorders presenting in primary care settings and (b) the organization of effective multidisciplinary care for primary care patients with common mental disorders and comorbid medical conditions. Dr. Katon's work revolutionized the care of psychiatric illnesses in primary care and other medical care settings to the benefit of countless patients worldwide.

O antídoto do mal: crítica de arte e loucura na modernidade brasileira

Em meados da década de 1940, a psiquiatra Nise da Silveira organizou ateliês de pintura e modelagem com os pacientes do Centro Psiquiátrico Pedro II. A produção desses ateliês – hoje acervo do Museu de Imagens do Inconsciente – chamou a atenção de cientistas e intelectuais da época. O interesse suscitado pelas obras não se restringia à sua utilidade no tratamento psiquiátrico: elas também exemplificavam um novo conceito de qualidade estética e, ainda, assumiam papel central num debate político mais amplo, sobre o lugar do louco e da loucura na sociedade. É com esse pano de fundo que se desenrolam as análises do livro, dividido em três capítulos. O primeiro traça um panorama do modernismo brasileiro. O segundo aborda as influências teóricas contidas na noção de “arte virgem”, do crítico de arte Mário Pedrosa. E, por fim, o terceiro faz uma análise comparativa da categoria de “arte virgem” com a de “arte bruta”, do intelectual francês Jean Dubuffet, salientando as especificidades da experiência brasileira. O autor se detém a uma problemática histórica, estudando um período marcado tanto pela ebulição da “arte informal” quanto pelo questionamento das práticas psiquiátricas, de onde resultou o reconhecimento da “arte de loucos”. A partir daí arte e loucura combinaram-se de tal forma que, hoje, quase ninguém duvida do potencial dessa união. “Este é um livro para artistas e críticos de arte e para profissionais que lidam com a loucura e a arte”, recomenda o editor da coleção

El arte-terapia y sus orígenes: una mirada histórica hacia Chile / Art-therapy and its origins: a historical glance to Chile

Frente al aumento de prevalencia de las enfermedades mentales, de los costos económicos y emocionales que ella traen como carga, consideramos necesario estudiar los nuevos métodos que se han comenzado a utilizar hace algunos años para combatir los problemas de salud mental. Creemos pertinente estudiar el Arte-terapia en Chile, como un camino válido para analizar cómo nace y evoluciona una nueva técnica en la sociedad chilena. Nuestro trabajo trata el recorrido histórico del Arte-terapia, analizando sus hitos más importantes desde los países iniciadores para luego llegar a Chile. Dentro de los principales resultados de nuestra investigación podemos observar que el Arte-terapia se está desarrollando en Chile hace 20 años por medio de diferentes maneras: su utilización en hospitales y colegios, así como en los recientes programas de formación en la Universidad de Chile y la creación de la Asociación de Arte-terapeutas Chilenos, entre otras iniciativas. Nuestro trabajo intenta mostrar algunos de estos caminos, los actores sociales que interactúan y los distintos discursos que surgen en su deseo de legitimarse como "terapia". (AU)

The Berlin tradition in Chicago: Franz Alexander and the Chicago Institute for Psychoanalysis.

Freud considered Franz Alexander, the first graduate of the Berlin Psychoanalytic Institute and an assistant in the Berlin Polyclinic, to be "one of our strongest hopes for the future." Alexander went on to become the first director of the Chicago Institute for Psychoanalysis in 1932 and modeled some of the Chicago Institute's mission on his Berlin experiences. He was also a researcher in psychosomatic medicine, a prolific writer about psychoanalysis and prominent in psychoanalytic organizations. As he proposed modifications in psychoanalytic technique, he became a controversial figure, especially in the elaboration of his ideas about brief therapy and the corrective emotional experience. This paper puts Alexander's achievements in historical context, draws connections between the Berlin and Chicago Institutes and suggests that, despite his quarrels with traditional psychoanalysis, Alexander's legacy may be in his attitude towards psychoanalysis, characterized by a commitment to scientific study, a willingness to experiment, and a conviction about the role of psychoanalysis within the larger culture.

[Penrose's law: reality or fiction? Mental health system and the size of prison population - international overview]. / Penrose-törvény: realitás vagy fikció? Az elmeegészségügy helyzete és a börtönpopuláció nagysága - nemzetközi kitekintés.

According to the Penrose's law, outlined on the basis of a comparative study of European statistics, there is an inverse relationship between the number of psychiatric beds and prison population. Based on international data, interrelationship among prison, asylum, psychiatric disease and criminal action are investigated in the present study, paying particular attention to the event of deinstitutionalization. Prevalence of mental and addictive diseases as well as psychological disturbances in prison is characterized by epidemiological data. As proposed by Penrose, an inverse relationship between the number of psychiatric beds and prison population can be observed in Hungary, too. To get a deeper insight into the mainstream of the events, economic, sociological, philosophical, as well as therapeutic aspects initializing deinstitutionalization are highlighted in the course of analysis. On the basis of data, it can be assumed that members the same population are confined to both systems. The author arrives at the conclusion that deinstitutionalization has in fact led to trans-institutionalization, because of, on one hand, the limited capacity of community treatment facilities; on the other hand, the community treatment itself cannot provide adequate treatment options to those suffering from severe, chronic mental diseases or comorbid states. In addition, the rate of financial support and the methods for prevention and treatment are insufficient to protect patients from the effects of revolving door.

The "magical" language of Mantra.

This paper aims to illuminate the phenomenon of mantras and to critique the category of magic through an examination of mantra as magical language. Mantras have often been referred to as "magic formulas" or "spells," yet one searches the scholarly literature in vain for a worthy explanation of precisely why mantra should or should not be considered magical. This essay addresses this lack, (a) explaining how mantra's conflict with modern Western understandings of language has led scholars to conceive of mantra as magic and (b) showing just what is at stake in such characterizations. This examination of mantra will demonstrate how "magic" and related terms have consistently been used not so much to describe as to marginalize and de-authorize that to which they refer. While the issue is partly about flawed terms and categories, the question of mantra as magic ultimately leads to an unsettling confrontation with the limits of our own modern rationalist perspective.

Exercises for mind and body: Giulio Mancini, collecting, and the beholding of landscape painting in the seventeenth century.

This article explores the intellectual foundations for the development of princely art collections, and of Italian picture galleries in particular, as spaces for combined physical and mental exercise and recreation. This study then establishes the relationship between the therapeutic function of picture galleries and the manner in which landscape paintings produced for princely collectors at this moment in Italy embodied ideals of both exercise and repose.

[Art, medical treatment and insanity: a territory in flux]. / Arte, clínica e loucura: um território em mutação.

Based on a combination of clinical and pedagogical experience in occupational therapy, which interlinks artistic practices and therapeutic processes, we carried out a historical study designed to investigate how the fields of mental health and art became interrelated in Brazil between the mid 19th and 20th centuries. The methods used for this research, which is underpinned by the thinking of Foucault, Deleuze and Guattari, were cartography and archeology. We used archeology to investigate the historical discourses and events, seeking out the forces behind them. Through cartography we sought to map out some lines which, emerging from each of these fields in relation to the other, intersect to form different patterns in the area under study.

Saúde mental: do velho ao novo paradigma - uma reflexão / Mental health: from the old to the new paradigm - a reflection

O texto desenvolve idéias desencadeadas a partir de reflexões teóricas e das vivências das autoras diante da compreensão histórica da psiquiatria e alguns pontos chaves da desinstitucionalização com o objetivo de vislumbrar possibilidades de um novo paradigma onde o ser humano possa ser visto como um cidadão em sofrimento e não mais como uma doença...

Religiousness and mental health: a review / Religiosidade e saúde mental: uma revisão

OBJECTIVE: The relationship between religiosity and mental health has been a perennial source of controversy. This paper reviews the scientific evidence available for the relationship between religion and mental health. METHOD: The authors present the main studies and conclusions of a larger systematic review of 850 studies on the religion-mental health relationship published during the 20th Century identified through several databases. The present paper also includes an update on the papers published since 2000, including researches performed in Brazil and a brief historical and methodological background. DISCUSSION: The majority of well-conducted studies found that higher levels of religious involvement are positively associated with indicators of psychological well-being (life satisfaction, happiness, positive affect, and higher morale) and with less depression, suicidal thoughts and behavior, drug/alcohol use/abuse. Usually the positive impact of religious involvement on mental health is more robust among people under stressful circumstances (the elderly, and those with disability and medical illness). Theoretical pathways of the religiousness-mental health connection and clinical implications of these findings are also discussed. CONCLUSIONS: There is evidence that religious involvement is usually associated with better mental health. We need to improve our understanding of the mediating factors of this association and its use in clinical practice.

OBJETIVO: A relação entre religiosidade e saúde mental tem sido uma perene fonte de controvérsias. O presente artigo revisa a evidência científica disponível sobre a relação entre religião e saúde mental. MÉTODO: Os autores apresentam os principais estudos e as conclusões de uma revisão sistemática abrangente dos estudos sobre a relação religião-saúde mental. Utilizando-se de várias bases de dados, a revisão identificou 850 artigos publicados ao longo do século XX. O presente artigo também inclui uma breve contextualização histórica e metodológica, além de uma atualização com artigos publicados após 2000 e a descrição de pesquisas conduzidas no Brasil. DISCUSSÃO: A ampla maioria dos estudos de boa qualidade encontrou que maiores níveis de envolvimento religioso estão associados positivamente a indicadores de bem estar psicológico (satisfação com a vida, felicidade, afeto positivo e moral mais elevado) e a menos depressão, pensamentos e comportamentos suicidas, uso/abuso de álcool/drogas. Habitualmente, o impacto positivo do envolvimento religioso na saúde mental é mais intenso entre pessoas sob estresse (idosos, e aqueles com deficiências e doenças clínicas). Mecanismos teóricos da conexão religiosidade-saúde mental e as implicações clínicas destes achados são discutidos. CONCLUSÕES: Há evidência suficiente disponível para se afirmar que o envolvimento religioso habitualmente está associado a melhor saúde mental. Atualmente, duas áreas necessitam de maior investimento: compreensão dos fatores mediadores desta associação e a aplicação deste conhecimento na pratica clínica.

Hydrotherapy as treatment of mental illness in XIXth century Mexico

Avant 1848, l´hydrothérapie était utilisée exclusivement sous la forme d'immersion en eau froide au Mexique. La première installation des douches thérapeutiques à l1Hôpital Militaire de la ville de Mexico est décrite en 1869. Environ ces dates, une partie des facilités - parmi eux les bains - de l'asile de San Hipólito, l'hôpital psychiatrique principal, ont été modernisées. Vers la fin du siècle, La Castañeda, un hôpital psychiatrique nouveau et bien équipé a été construit. Ces plans ont été fondés sur les suggestions du 5ème Asile sur Seine. Selon les commissions, chaque pavillon consistait d'une surface de 730 mètres carrés et avait une piscine, des douches, des salles de massage et de pédiluve. Quelques maladies traitées par des méthodes d'hydrothérapie étaient la clorose, l'hypocondrie, la manie, la mélancolie, épilepsie et la paralysie.(AU)

Instinct, "primitive" cognition, and the transformation of intuition.

This paper explores epistemological and historical relationships between "instincts" and "intuition". First, it discusses epistemological connotations of the instinct concept, specifically the implication of a kind of innate knowledge imbedded in the assumption of unlearned behavior as this emerges in evolutionary theory and 19th century comparative psychology. Second, it claims that while the intuition concept foreshadows (in some ways) the appeal to instinct, the instinct concept in turn contributes to changes in the concept of intuition.

Darwinian psychology, old and new.

Many senior American and British psychologists between c1890 and c1925 were engaged in an attempt to settle on a unified definition of the term "instinct" as a psychological construct. Whilst this enterprise failed, some of its basic concepts underpin today's project of evolutionary psychology. This claim is substantiated by an analysis of the similarities between William McDougall's "Social Psychology" (1908), in which he articulated his theory of instincts, and John Tooby's and Leda Cosmides' "The Psychological Foundations of Culture" (1992). It is argued that Tooby's and Cosmides' approach faces similar problems as were faced by McDougall's theory of instincts.

Doença mental e democracia na Bolívia: o Manicomio Pacheco, 1935-1950 / Mental disease and democracy in Bolivia: the Manicomio Pacheco, 1935-1950

Examina, por meio do estudo dos registros do Manicomio Pacheco e dos escritos de médicos que trabalharam com pacientes mentais, quem era considerado mentalmente doente e como eram tratados na Bolívia da década de 1940. Indaga se as novas políticas democráticas e populistas do período influenciaram a prática psiquiátrica, e que impacto classe social e gênero tinham no diagnóstico e no tratamento. Examina como os médicos entendiam a capacidade intelectual e a estabilidade emocional de índios e mulheres, dois grupos que, na sociedade boliviana, näo tinham direitos integrais de cidadania. (AU)