Trans(gender) journeys: rights and the (non-)recognition of "human".

A human right paradigm has been challenging the biomedical perspectives that tend to be normalized in the Western context concerning the lives of trans people. The aim of this study is to understand how trans people in Portugal and Brazil perceive the (non-)recognition of their socio-cultural, economic and political rights. Specifically, the study intends to know in what extent these perceptions influence the processes of identity (de)construction. For this purpose, 35 semi-structured interviews were conducted with people self-identified as trans, transsexuals and transvestites in Brazil and Portugal. The narratives of the participants were analyzed according to the thematic analysis method and the following six main themes emerged: (i) Who are the rights for; (ii) Types of rights; (iii) Paradigm of distribution of rights; (iv) Local or global rights; (v) Non-recognition of the "human"; and, (vi) Transphobias (and cissexism). The results allowed the knowledge of rights and the non-recognition of the "human" which is the central organizer of the analysis. Among the main conclusions of this study, we emphasize the circumscription of rights to certain international, regional and/or national contexts; the existence of local instead of global rights, since they are influenced by regional and international law, but they depend on the legislation in force in each country; and the way human rights can also be understood as a platform of invisibility and exclusion of other people. Based on a commitment to social transformation, this article also contributes to rethinking the violence that is exercised on trans people as a continuum, whether through 'normalizing devices' by medical contexts, family contexts, public space, or even through internalized transphobia. Social structures produce and sustain transphobias and, simultaneously, are responsible for fighting them by changing the paradigm about the conception of transsexualities.

Visualizing BDSM and AIDS Activism: Archiving Pleasures, Sanitizing History.

The visual archive of AIDS and fetish activism is a rich resource for studying interlinkages between art and science, activism and public health, politics and medicine, pleasure and sexual health prevention. This article explores AIDS and fetish activism imagery from the first two decades of the Norwegian AIDS crisis. Interrogating the materiality and visual context of images - photographs, posters, flyers, and safer sex instructions - it maps out visualization practices in leather, BDSM and AIDS activism. AIDS and fetish imagery made some bodies, pleasures, and political goals visible - and rendered others unseen. The article explores the materiality of images and their visual, social, and historical context of production, and traces their social biographies and afterlives. Fetish images were vehicles for change and actors co-producing history. They took part in destigmatizing BDSM, challenging psychiatric classification, and creating infrastructure and networks between subcultures, communities, and authorities. The visualization of fetish activism was as much about communication strategies as it was about aesthetic, style, and motive. The politics of visibility in Norwegian fetish activism point to the vulnerable project of fighting for acceptance through "respectability," while preserving the individuality and "otherness" of leather and fetish culture.

Obvious benefits but hidden costs: A critical exploration of the impact of adopting the "master narrative" in Alcoholics Anonymous.

INTRODUCTION: New members of Alcoholics Anonymous (AA) typically acquire a distinct "alcoholic" identity, including AA-specific understandings of their "alcoholism" and what it means to be in recovery. Although much qualitative research on AA has presented the experiences of members who have embraced this identity and have been wholly praising of AA, other theorists have been strongly critical of the organization, often arguing that it emulates a cult. To contribute towards reconciling these competing bodies of research, the current study aimed to critically explore the impact of adopting AA's master narrative. METHODS: The study involved 19 prospective, in-depth semi-structured interviews with six AA members recruited from meetings across Sydney, Australia. Data were analyzed thematically using a master narrative theoretical framework. RESULTS: The study identified three core components of AA's master narrative: (1) Powerlessness over alcohol ("alcoholics" are powerless over alcohol); (2) Internalized pathologization ("alcoholics" are mentally and emotionally sick, above and beyond their problems with alcohol); and (3) AA as the only solution for wellness (involvement in AA is the necessary requirement for "alcoholics" to become and remain well). Although most participants emphasized the positive experiences from internalizing the AA narrative, our analysis also revealed potentially negative ramifications of this narrative on their self-conceptions and worldviews that were seemingly unrecognized by participants themselves. CONCLUSIONS: The master narrative framework facilitated a critical and balanced exploration of AA members' experiences. Although AA's master narrative is valuable for members, it could also carry costs that need to be mitigated by resources both inside and outside of AA.

Weeping wombs: Leucorrhea and the chronicity of distress in Gilgit-Baltistan.

In Gilgit, capital of the Gilgit-Baltistan region in northern Pakistan, leucorrhea - vaginal discharge known in the vernacular as safaid pani, or 'white water' - serves as both a medical diagnosis and signifier of the chronicity of the reproductive, social, and emotional burdens endured by women. While ethnomedical providers explained safaid pani as resulting from relatively benign forms of 'weakness', which required minimal dietary or ethno-botanical recourse, allopathic physicians approached discharge as evidence of numerous pathologies that necessitated protracted and sometimes also expensive treatments. Physicians' clinical assessments were not solely biomedical, but also integrated informal folk and formal ethnomedical theories of causation. Clinical diagnoses that affirmed leucorrhea as a pathophysiology substantiated women's belief that it was proof of the destructive effects of sustained social inequity, peril, and distress on the body, and the uterus in particular. Women and their treating providers recognized the power of the (dys)functional uterus to not only threaten women's reproductive wellness but also their social, marital, and familial status, which hinged on their ability to become pregnant and give birth, to sons especially. Because of the ailing uterus's expansive importance, weeping wombs served as a potent source for women's claims making and calls for attention and care.

Taking the Long Way Around: Towards A Depathologized Ethical Framework of Gender-Affirming Care for Trans Youth.

Political debate regarding trans youth's access to gender-affirming care (GAC) has pushed many to advocate for GAC by pointing to tragic, pathological outcomes of non-treatment, namely suicide. However, these pathologized arguments are a harmful ethical "shortcut" which should be replaced by a meaningful engagement with the ethics of providing GAC to youth.

A patologização do comportamento humano como pressuposto da medicalização do sentir / The pathologization of human behavior as a presumption for the medicalization of feeling / La patologización del comportamiento humano como presunción para la medicalización del sentimiento

Atualmente, dados apontam haver um considerável número de pessoas com diagnóstico de transtornos mentais. Assim, esses dados crescem vertiginosamente a cada ano ao nível mundial. Tal fato chama atenção para a questão de que, na atualidade, a maioria desses problemas possam, equivocadamente, estar sendo tratados como algum tipo de transtorno mental. Portanto, a abordagem principal visa uma análise da patologização do comportamento humano, como pressuposto da medicalização do sentir. Este trabalho objetivou demonstrar a contribuição determinante que o fenômeno social da patologização do comportamento humano possui para a prática indiscriminada da medicalização do sentir. Para tanto, utilizou-se da análise de conteúdo para criar categorias de análises e de uma revisão integrativa que seguiu as seis etapas prescritas na literatura. Para o cumprimento, utilizaram-se os Descritores em Ciências da Saúde (DecS): Comportamento e Medicalização além da palavra-chave patologização durante os meses de setembro a outubro de 2022, nas seguintes plataformas: Scientific Electronic Library Online (SCIELO), Periódicos Eletrônicos em Psicologia (PEPSIC), Scopus (Elsevier), Literatura Latino-americana e do Caribe em Ciências da Saúde (LILACS), Biblioteca Virtual em Saúde (BVS), Pubmed além dos portais CAPES. A partir dos critérios de elegibilidade, 61 produções foram recuperadas, sendo utilizadas apenas duas para a análise final. Os resultados trazem à baila a possibilidade da adoção de métodos outros que não a medicalização como primeira e/ou única opção de tratamento. Por fim, limitações e sugestões de pesquisa são analisadas ao final.

Currently, data indicate that there is a considerable number of people diagnosed with mental disorders. Thus, this data grows vertiginously every year worldwide. This fact draws attention to the fact that, currently, most of these problems may be mistakenly being treated as some kind of mental disorder. Therefore, the main approach aims at an analysis of the pathologization of human behavior, as an assumption of the medicalization of feeling. This work aimed to demonstrate the decisive contribution that the social phenomenon of the pathologization of human behavior has for the indiscriminate practice of the medicalization of feeling. For that, content analysis was used to create analysis categories and an integrative review that followed the six steps prescribed in the literature. For compliance, the Descriptors in Health Sciences (DecS): Behavior and Medicalization were used in addition to the keyword pathologization during the months of September to October 2022, on the following platforms: Scientific Electronic Library Online (SCIELO), Periódicos Eletrônicos in Psychology (PEPSIC), Scopus (Elsevier), Latin American and Caribbean Literature in Health Sciences (LILACS), Virtual Health Library (BVS), Pubmed in addition to CAPES portals. Based on the eligibility criteria, 61 productions were retrieved, with only two being used for the final analysis. The results bring up the possibility of adopting methods other than medicalization as the first and/or only treatment option. Finally, limitations and research suggestions are analyzed at the end.

Actualmente, los datos indican que existe un número considerable de personas diagnosticadas con trastornos mentales. Así, este dato crece vertiginosamente cada año a nivel mundial. Este hecho llama la atención sobre el hecho de que, en la actualidad, la mayoría de estos problemas pueden estar siendo erróneamente tratados como algún tipo de trastorno mental. Por lo tanto, el enfoque principal apunta a un análisis de la patologización del comportamiento humano, como supuesto de la medicalización del sentimiento. Este trabajo tuvo como objetivo demostrar la decisiva contribución que tiene el fenómeno social de la patologización del comportamiento humano para la práctica indiscriminada de la medicalización del sentimiento. Para eso, se utilizó el análisis de contenido para crear categorías de análisis y una revisión integradora que siguió los seis pasos prescritos en la literatura. Para el cumplimiento, se utilizaron los Descriptores en Ciencias de la Salud (DecS): Comportamiento y Medicalización además de la palabra clave patologización durante los meses de septiembre a octubre de 2022, en las siguientes plataformas: Scientific Electronic Library Online (SCIELO), Periódicos Eletrônicos en Psicología ( PEPSIC), Scopus (Elsevier), Literatura Latinoamericana y del Caribe en Ciencias de la Salud (LILACS), Biblioteca Virtual en Salud (BVS), Pubmed además de los portales de la CAPES. Según los criterios de elegibilidad, se recuperaron 61 producciones, y solo dos se usaron para el análisis final. Los resultados plantean la posibilidad de adoptar métodos distintos a la medicalización como primera y/o única opción de tratamiento. Finalmente, al final se analizan las limitaciones y sugerencias de investigación.

Transporting the Burden of Justification: The Unethicality of Transgender Conversion Practices.

Transgender conversion practices involve attempts to alter, discourage, or suppress a person's gender identity and/or desired gender presentation, including by delaying or preventing gender transition. Proponents of the practices have argued that they should be allowed until proven to be harmful. Drawing on the notion of expressive equality, I argue that conversion practices are prima facie unethical because they do not fulfill a legitimate clinical purpose and conflict with the self-understanding of trans communities.

Addressing Trauma in Adaptive Physical Activity: A Call to Reflection and Action.

Trauma is pervasive, embodied, and can be perpetrated or perpetuated by researchers, educators, and practitioners, including those within adaptive physical activity (APA). In this article, we highlight the need to address trauma within APA as a matter of access and justice. We share various conceptualizations of trauma from psychiatric, embodied, anti-pathologizing, and sociopolitical perspectives. Trauma-informed practice is introduced as a framework for creating safer, more inclusive programs and services, so we can recognize the impacts of trauma and affirm those who experience it. As the first step to a multistep trauma-informed process, our aim is to raise awareness of trauma and introduce resources for enacting trauma-informed practice. We also pose difficult questions about how we, as "helping" practitioners, researchers, and educators may be perpetuating or perpetrating harm and trauma, in particular sanism, within our profession. Ultimately, we invite readers to join us in reflection and action toward anti-pathologizing trauma-informed APA.

Mining sick: Creatively unsettling normative narratives about industry, environment, extraction, and the health geographies of rural, remote, northern, and Indigenous communities in British Columbia.

Rural, remote, northern, and Indigenous communities on Turtle Island are routinely-as Cree Elder Willie Ermine says-pathologized. Social science and health scholarship, including scholarship by geographers, often constructs Indigenous human and physical geographies as unhealthy, diseased, vulnerable, and undergoing extraction. These constructions are not inaccurate: peoples and places beyond urban metropoles on Turtle Island live with higher burdens of poor health; Indigenous peoples face systemic violence and racism in colonial landscapes; rural, remote, northern, and Indigenous geographies are sites of industrial incursions; and many rural and remote geographies remain challenging for diverse Indigenous peoples. What, however, are the consequences of imagining and constructing people and places as "sick"? Constructions of "sick" geographies fulfill and extend settler (often European white) colonial narratives about othered geographies. Rural, remote, northern, and Indigenous geographies are discursively "mined" for narratives of sickness. This mining upholds a sense of health and wellness in southern, urban, Euro-white-settler imaginations. Drawing from multi-year, relationship-based, cross-disciplinary qualitative community-informed experiences, and anchored in feminist, anti-colonial, and anti-racist methodologies that guided creative and humanities-informed stories, this paper concludes with different stories. It unsettles settler-colonial powers reliant on constructing narratives about sickness in others and consequently reframes conversations about Indigenous well-being and the environment.

Les communautés autochtones, nordiques et rurales de Turtle Island sont, comme le dit l'aîné cri Willie Ermine, couramment considérées comme pathogènes. Le discours professoral en sciences sociales et en santé, y compris chez les géographes, conçoit souvent les géographies autochtones, tant humaines que physiques, comme étant malsaines, malades, vulnérables et soumises à l'extraction. Ces conceptions ne sont pas erronées: les gens et les endroits en dehors des agglomérations urbaines sur Turtle Island sont davantage exposés à un état de santé précaire, les Autochtones font face à une violence et un racisme systémique dans les milieux coloniaux, les géographies autochtones, nordiques et rurales sont le siège d'incursions industrielles et de nombreux contextes territoriaux ruraux et éloignés continuent de présenter un défi pour diverses populations autochtones. Toutefois, quelles sont les conséquences d'imaginer et de concevoir les gens et les endroits comme étant « malades ¼? Le concept de territoires « malades ¼ favorise et consolide les récits coloniaux (souvent le blanc européen) sur l'état d'autres territoires, lesquels seraient dans une situation plus favorable. Les géographies autochtones, nordiques et rurales sont alors « minées ¼ de manière discursive par les récits sur leur caractère pathogène. Ce minage soutient une impression de santé et de bien­être dans l'imaginaire colonial, blanc européen et urbain des populations du sud. S'inspirant d'expériences communautaires qualitatives éclairées interdisciplinaires pluriannuelles axées sur les relations et ancrées dans les méthodologies féministes, anticoloniales et antiracistes qui ont guidé les discours créatifs inspirés par les sciences humaines, le présent texte se termine avec des récits différents. Ceux­ci déstabilisent les pouvoirs coloniaux qui se fondent sur le concept de territoire pathogène et, par conséquent, ré­interprètent les perceptions et les affirmations sur l'environnement et le bien­être des Autochtones.

The discursive transformation of grief throughout history.

In recent decades, the phenomenon of grief, when you lose a loved one, has been the subject of exploration and discussion among researchers. Because of this, prolonged grief is now recognized as a possible mental disorder as the latest version of the diagnosis manual; 'International Classification of Diseases' (ICD-11) being published in 2018 is featuring a new diagnosis called 'prolonged grief disorder'. The commencement of this new disorder indicates a shift in the way grief is being articulated why the notion of rupture from the French philosopher Michel Foucault is applied as a philosophical approach in this paper. A Foucault-inspired discourse analysis has been prepared and by considering the issue historically and tracing how the concept of grief has been articulated in different time periods throughout history, the aim is to map out the discursive transformation that has taken place and to gain insight into how the societal context has supported and enabled this transformation. This paper takes a historical look back from the 1800s to present and identifies when changes can be observed in the way grief is being articulated. These changes or ruptures are identified in the work of Søren Aabye Kierkegaard, Sigmund Freud and Margaret Stroebe & Henk Schut who all must be assumed to have contributed significantly to how grief is perceived in various historical time periods. The discourse analysis identifies how prominent thinkers have articulated grief in each period and how today's perception of grief, as a possible mental disorder, both relates to these prominent thinkers but also reflects dominant societal values and ideologies.

O DIAGNÓSTICO DE TDAH E SEUS EFEITOS DE SUBJETIVAÇÃO: UMA ANÁLISE DAS TRAJETÓRIAS ESCOLARES DE JOVENS UNIVERSITÁRIOS / THE DIAGNOSIS OF ADHD AND ITS SUBJECTIVATION EFFECTS: AN ANALYSIS OF THE EDUCATIONAL TRAJECTORIES OF YOUNG UNIVERSITY STUDENTS / EL DIAGNÓSTICO DEL TDAH Y SUS EFECTOS DE SUBJETIVACIÓN: UN ANÁLISIS DE TRAYECTORIAS ESCOLARES DE JÓVENES UNIVERSITARIOS

Esta pesquisa teve por objetivo analisar as trajetórias escolares de jovens universitários diagnosticados com Transtorno de Déficit de Atenção e Hiperatividade (TDAH) e os efeitos de subjetivação decorrentes da experiência e apropriação desse diagnóstico. Foram entrevistados três estudantes matriculados em uma universidade da Grande Florianópolis (SC). A análise das narrativas foi realizada a partir da perspectiva teórico-metodológica da "análise de práticas discursivas", tal como proposta por Spink e Medrado (2013). Destacaram-se os efeitos de subjetivação dos processos de patologização e medicalização, com ênfase nas trajetórias escolares. Considerou-se que os sentidos das experiências do diagnóstico de TDAH são construídos, sobretudo, a partir de referentes discursivos típicos das racionalidades médico-psiquiátricas, que operam como um significativo regime de saber-poder subjetivante. Observou-se, também, que a medicalização da educação e da vida é um processo recorrente para adaptar os sujeitos em suas trajetórias escolares.

The goal of this study was to analyze educational trajectories of university students diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) and the subjectivation effects arising from the experience and appropriation of this diagnosis. Three students enrolled at a university in Greater Florianópolis (SC) were interviewed. The analyses of the narratives were carried out from the theoreticalmethodological perspective of the "discursive practices analyses", as it has been proposed by Spink and Medrado (2013). The subjectification effects of pathologization and medicalization processes were highlighted, with emphasis on educational trajectories. It was considered that the meanings of the experiences of the diagnosis of ADHD are constructed, mainly, from typical psychiatric discursive referents, which operate as a significant power-knowledge subjectivation regime. It was also observed that the medicalization of life and education is a recurrent process to adapt the subjects in their educational trajectories.

Esta investigación tuvo como objetivo analizar las trayectorias escolares de jóvenes universitarios diagnosticados con trastorno de déficit de atención e hiperactividad (TDAH) y los efectos de la subjetivación, resultantes de la experiencia y de la apropiación de este diagnóstico. Se entrevistó a tres estudiantes matriculados en una universidad en Florianópolis (SC). El análisis de las narrativas se realizó desde la perspectiva teórico-metodológica del "análisis de las prácticas discursivas", según proponen Spink y Medrado (2013). Se destacaron los efectos de subjetivación de los procesos de patologización y medicalización, con énfasis en las trayectorias escolares. Se constató que los sentidos de las experiencias del diagnóstico de TDAH se construyen, sobre todo, a partir de referentes discursivos típicos de las racionalidades médico-psiquiátricas, que operan como un significativo régimen de saber-poder subjetivante. También se observó que la medicalización de la educación y la vida es un proceso recurrente para adaptar a los sujetos en sus trayectorias escolares.

The Misuse of Gender Dysphoria: Toward Greater Conceptual Clarity in Transgender Health.

The notion of gender dysphoria is central to transgender health care but is inconsistently used in the clinical literature. Clinicians who work in transgender health must understand the difference between the diagnosis of Gender Dysphoria as defined and described in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders and the notion of this term as used to assess eligibility for transition-related interventions such as hormone-replacement therapy and surgery. Unnecessary diagnoses due to the belief that a diagnosis is clinically required to access transition-related care can contribute to stigma and discrimination toward trans individuals.

Herramientas conceptuales para contrarrestar la patologización trans en la formación de Psicología en Argentina / Conceptual tools to counteract trans pathologization in psychology training in Argentina / Ferramentas conceituais para combater a patologização das pessoas trans na formação da Psicologia na Argentina

Resumen Este trabajo argumenta que es urgente detener y revertir la patologización de las experiencias trans en la formación de psicología en Argentina. Para el abordaje de este problema, se presenta una propuesta basada en la combinación de dos enfoques teóricos: el de la salud mental comunitaria y el de los estudios trans. A partir de esta articulación, se propone, en primer término, realizar una lectura crítica que de cuenta del rol fundamental que la formación de psicología continúa teniendo con respecto a la patologización trans en Argentina. Y, en segundo término, introducir en la formación de psicología, aquellos conceptos provenientes del campo de los estudios trans que pueden realizar aportes muy significativos al campo de la salud mental para la comprensión adecuada de las experiencias trans. Se toma como caso de análisis un texto de orientación psicoanalítica de reciente publicación en este país. Y se presentan tres herramientas conceptuales en particular: escucha, transfobia y performatividad de género, tal como son planteadas en los desarrollos teóricos de Leila Dumaresq, Miquel Missé y Susan Stryker, respectivamente.

Abstract This work argues that it is urgent to stop and reverse the trans pathologization in psychology training in Argentina. To address this problem, a proposal based on the combination of two theoretical approaches is presented: that of community mental health and that of trans studies. Based on this articulation, it is proposed, first of all, to carry out a critical reading that takes into account the fundamental role that psychology training continues to play with respect to trans pathologization in Argentina. And, secondly, to introduce in psychology training, those concepts from the field of trans studies that can make very significant contributions to the field of mental health for the adequate understanding of trans experiences. It is taken as a case of analysis, a text of psychoanalytic orientation recently published in this country. And three conceptual tools in particular are presented: listening, transphobia and gender performativity, as they are raised in the theoretical developments of Leila Dumaresq, Miquel Missé and Susan Stryker, respectively.

Resumo Este trabalho argumenta que é urgente reverter a patologização das experiências trans na formação da Psicologia na Argentina. Para enfrentar esse problema, é apresentada uma proposta baseada na combinação de duas abordagens teóricas: a da saúde mental comunitária e a dos estudos trans. A partir dessa articulação, o artigo propõe, em primeiro lugar, fazer uma leitura crítica que leve em conta o papel fundamental que a formação em psicologia continua a desempenhar no que diz respeito à patologização das pessoas trans na Argentina. E, em segundo lugar, introduzir na formação em psicologia conceitos do campo dos estudos trans que possam trazer contribuições muito significativas ao campo da saúde mental para a compreensão adequada das experiências trans. Toma-se como caso de análise um texto de orientação psicanalítica recentemente publicado na Argentina e três ferramentas conceituais são apresentadas: escuta, transfobia e performatividade de gênero, conforme são abordadas nos estudos de Leila Dumaresq, Miquel Missé e Susan Stryker, respectivamente.

Reduccionismo biomédico y patologización en la atención de salud mental ¿Estamos sobremedicalizando en la atención primaria? / Biomedical reductionism and pathologization in mental health care. are we overmedicalizing in primary care?

La inserción de la salud mental en una atención primaria (APS) integradora ha sido una política exitosa para reducir la brecha en el tratamiento de personas que padecen trastornos mentales (TMs). Sin embargo, las consecuencias de este progreso pudiesen estar yendo más allá de las deseables. Este despliegue sustancioso de la atención de salud mental podría estar también estimulando la medicalización la vida cotidiana de las personas de manera más activa y en consecuencia coadyuvar a desactivar la potencia socializadora y trasformadora del malestar en la sociedad. En este trabajo me propongo comprender cómo los programas de salud mental en APS pudiesen estar contribuyendo a trasformar en problemas médicos expresiones del diario vivir que no lo son. Luego de examinar algunos aspectos de las políticas relacionadas con la salud mental, informes e investigaciones, sugiero que el diseño del plan de Garantías Explícitas en Salud, las tecnologías utilizadas para integrar y desarrollar la atención de salud mental, y ciertas circunstancias derivadas de este proceso, podrían estar estimulando la sobrevivencia de un modelo biomédico reduccionista y patologizador que respaldaría prác-ticas medicalizadores. Algunas sugerencias son esbozadas para el desarrollo de una política y práctica en salud que reconozca e integre la posibilidad para mitigar los potenciales efectos negativos de este fenómeno. (AU)

The insertion of mental health in comprehensive primary care (PC) has been a successful policy to reduce the gap in the treatment of people with mental disorders (MDs). However, the consequences of this progress may exceed what is desirable. This substantial deployment of mental health care could also be stimulating the medicalization of people's daily lives in a more active way and consequently help to deactivate the socializing and transformative power of discomfort in society. In this work, I intend to understand how the mental health programs in PC could be contributing to transform expressions of daily living into medical problems that are not. After examining some aspects of mental health related policies, reports, and research, I suggest that the design of the Explicit Health Guarantees plan, the technologies used to in-tegrate and develop mental health care, and certain circumstances derived from this process, could be stimulating the survival of a reductionist and pathologizing biomedical model that would support medicalizing practices. Some suggestions are outlined for the development of health policy and practice that recognises and integrates the possibility to mitigate the potential adverse effects of this phenomenon. (AU)

História das abordagens científicas, médicas e psicológicas sobre as transexualidades e suas aproximações críticas / A history of scientific, medical and psychological approaches to transsexualities and their critical approach

Resumo Neste artigo, apresenta-se um breve enquadramento histórico das abordagens científicas, médicas e psicológicas sobre as transexualidades, tecendo um conjunto de considerações sobre a forma como tal enquadramento foi fundacional da noção de patologia associada às pessoas trans e como tem sido responsável pela manutenção da patologização destes indivíduos no imaginário coletivo. Para atingir tal objetivo, é desenhado um mapa cronológico dos acontecimentos que têm vindo a marcar, ao longo da história, o estudo e a intervenção com as pessoas trans a partir do modelo biomédico, referenciando algumas das personalidades que, no contexto ocidental, tiveram responsabilidade nesta visão biomédica das pessoas trans. No final deste trabalho, apresenta-se a discussão em torno da (des)patologização das transexualidades a partir do surgimento do paradigma centrado nos direitos humanos das pessoas trans e em propostas de autodeterminação dos seus corpos e identidades.

Abstract This study provides a brief historical background of scientific, medical and psychological approaches to transsexualities. It also makes considerations on how such approaches based the concept of pathology that is associated with trans people and how it has been responsible for maintaining the pathologization in the collective imaginary. More specifically, we will establish a chronology of events that, throughout history, have affected the study on and the intervention with trans people, based on the biomedical model. We will also refer to some Western figures responsible for creating this biomedical vision of trans people. Finally, the discussion about the (de)pathologization of transsexualities is presented, based on the emergence of the paradigm centered on the human rights of trans people and proposals for self-determination of their bodies and identities.

La patologización de la homosexualidad en los manuales diagnósticos y clasificaciones psiquiátricas / The pathologization of homosexuality in diagnostic manuals and psychiatric classifications

Investigaremos la relación entre el diagnóstico en la atención de la Salud Mental y la clasificación de la homosexualidad como enfermedad o trastorno mental con el fin de analizar que en lo que a las sexualidades no hegemónicas respecta, el diagnóstico no supone ser únicamente un conocimiento acabado del fenómeno que pretende investigar, sino que funciona como un procedimiento performativo que produce el mismo fenómeno que busca delimitar. Para ello, consideraremos los "Principios para la protección de los enfermos mentales" adoptados por la Asamblea General de las Naciones Unidas el 17/12/1991, así como los sistemas internacionalmente vigentes de Clasificación en Salud Mental. Nuestra hipótesis de trabajo descansa también en las ideas sobre la performatividad desarrolladas por Judith Butler (AU)

We will analyze the relationship between diagnosis in Mental Health Care and the classification of homosexuality as a mental illness. We will reflect that as far as non-hegemonic sexualities are concerned, the diagnosis does not suppose to be a complete knowledge of the phenomenon that it seeks to investigate, but rather works as a performative procedure that produces the same phenomenon that it seeks to know and delimit. We will take into account the "Principles for the protection of the mentally ill" adopted by the United Nations General Assembly in its resolution 46/119 (12/17/1991) and the existing systems of classification in Mental Health. Our working hypothesis rests on the ideas of performativity developed by Judith Butler (AU)

Investigarem la relació entre el diagnòstic en l'atenció de la Salut Mental i la classificació de l'homosexualitat com a malaltia o trastorn mental amb la finalitat d'analitzar que pel que respecta a les sexualitats no hegemòniques , el diagnòstic no suposa ser únicament un coneixement acabat del fenomen que pretén investigar, sinó que funciona com un procediment performatiu que produeix el mateix fenomen que busca delimitar. Per a això, considerarem els "Principis per a la protecció dels malalts mentals" adoptats per l'Assemblea General de les Nacions Unides el 17/12/1991, així com els sistemes internacionalment vigents de Classificació en Salut Mental. La nostra hipòtesi de treball descansa també en les idees sobre la performativitat desenvolupades per Judith Butler (AU)

Um lugar ético para o adulto na relação com crianças e adolescentes: Bernfeld e o para além da patologização / An ethical place for adults in their relationship with children and adolescents: Bernfeld and beyond pathologization / Un lugar ético para los adultos en su relación con niños y adolescentes: Bernfeld y más allá de la patologización

Siegfried Bernfeld foi um psicanalista, discípulo de Freud, e um pioneiro na articulação entre educação e psicanálise. Além disso, fundou a Colônia Infantil de Baumgarten, uma experiência educacional de ponta na qual deu as boas-vindas aos órfãos de guerra. Neste artigo resgatamos seu trabalho no sentido de refletir sobre o mal-estar do psicanalista e educador diante da criança ou adolescente que não corresponde ao que se espera. Advertindo-nos que o mal-estar do adulto diante da criança e adolescente fora do esperado pode instaurar defesas autoritárias e patologizantes, Bernfeld advoga um outro lugar, ético e expectante, na relação adulto-criança. Resgatar as concepções desse pioneiro objetiva incrementar a reflexão sobre o crescente movimento de patologização no cenário contemporâneo. Na atualidade, à medida que o diagnóstico passa a ser prioritariamente concebido pelo neurobiológico e pelo comportamental, a escola também passa a ocupar a função de identificar a soma dos comportamentos desviantes, encaminhando rapidamente a criança ou adolescente para serviços de saúde mental. Em outro sentido, menos imediato, tolerar algo sobre não saber em relação à criança exigiria que o adulto assumisse parcialmente sua própria estranheza constitutiva. O "não querer saber", marca de todo adulto, poderia, assim, abrir algumas lacunas no querer saber sobre o mal-estar e a inquietação que a criança e o adolescente não modelares nos causam. Tanto o psicanalista quanto o educador não têm certeza, nem podem prever os resultados de suas intervenções. Bernfeld nos ensina que somente quando o educador reconhece e aceita seus próprios limites será possível criar uma nova pedagogia, uma pedagogia dos limites contra a onipotência dos pedagogos.

Siegfried Bernfeld was a psychoanalyst, a disciple of Freud and a pioneer in the articulation between education and psychoanalysis. In addition, he founded Baumgarten Children's Colony, a cutting-edge educational experience in which he welcomed war orphans. In this dossier we recall his work to reflect on the uneasiness of the psychoanalyst and educator towards the child or adolescent that does not correspond to what is expected. Warning us that the malaise of the adult in front of the child and adolescent outside of what is expected can establish authoritarian and pathological defenses, Bernstein advocates another place, ethical and expectant in the adult-child relationship. Rescuing the conceptions of this pioneer aims to increase reflection on the growing movement of pathologization in the contemporary scenario. Nowadays, as the diagnosis becomes primarily conceived by the neurobiological and behavioral, the school also starts to occupy the function of identifying the sum of deviant behaviors, quickly referring the child or adolescent to mental health. In another, less immediate sense, tolerating something about not knowing about the child would require the adult to partially assume his or her own constitutive strangeness. The "not knowing", a mark of every adult, could thus open some gaps in wanting to know about the uneasiness and restlessness that the child and adolescent do not model on us. Both the psychoanalyst and the educator are not sure, nor can they predict the results of their interventions. Bernfeld teaches us that only when the educator recognizes and accepts his own limits will it be possible to create a new pedagogy, a pedagogy of limits against the omnipotence of pedagogues.

Siegfried Bernfeld fue un psicoanalista, discípulo de Freud, y un pionero en la articulación entre educación y psicoanálisis. Además, fundó la Colonia Infantil de Baumgarten, una experiencia educativa de vanguardia en la cual amparó a los huérfanos de la guerra. En este artículo rescatamos su trabajo para reflexionar sobre el malestar del psicoanalista y educador delante del sujeto que transita la infancia o la adolescencia y que no guarda correspondencia con lo esperado. Advirtiéndonos que el malestar del adulto delante del sujeto que transita la infancia o la adolescencia por fuera de lo esperado puede instaurar defensas autoritarias y patologizantes, Bernfeld aboga un otro lugar, ético y espectante en relación al adulto. El objetivo es rescatar las concepciones de este pionero para incrementar la reflexión sobre el creciente movimiento de patologización en el escenario contemporáneo. En la actualidad, en la medida que el diagnóstico pasa a ser prioritario, desde una concepción neurobiológica y comportamental, la escuela también pasa a ocupar la función de identificar la suma de comportamientos desviados, derivando rápidamente a la niña, niño o adolescente para ser medicalizado/patologizado. En otro sentido, menos inmediato, tolerar algo del no saber en relación a ese sujeto que transita la infancia o la adolescencia exigiría que el adulto asuma parcialmente su propia extrañeza constitutiva. El "no querer saber", la marca de todo adulto, podría abrir así algunas lagunas de querer saber sobre la inquietud y malestar que suscita nuestra extrañeza actualizada por la niña, niño o adolescente que no condice con el modelo. Tanto el psicoanalista como el educador no están seguros, ni pueden predecir los resultados de sus intervenciones. Bernfeld nos enseña que solo cuando el educador reconozca y acepte sus propios límites será posible crear una nueva pedagogía, pedagogía de los límites contra la omnipotencia de los pedagogos.

La enfermedad normal: Aspectos históricos y políticos de la medicalización del parto / The normal disease: Historical and political aspects of the medicalization of childbirth / A enfermidade normal: Aspectos históricos e políticos da medicalização do parto

Resumen Este artículo indaga sobre la construcción del saber y la práctica médica en ginecobstetricia. Se centra específicamente en las transformaciones de los significados sociales y médicos sobre el cuerpo gestante y parturiente que se dieron desde finales del siglo XIX y en el transcurso del siglo XX, y que posibilitan el proceso de medicalización, patologización y hospitalización del parto. Así mismo, se exploran los efectos que tiene el modelo médico tecnocrático de atención al binomio embarazo/parto, en cuanto a la experiencia de dichos procesos en las mujeres. El artículo concluye en la necesidad de profundizar en los elementos del paradigma médico, la formación de los profesionales y las condiciones laborales del sector de la salud, que intervienen en la problemática de la deshumanización de la atención del parto.

Abstract This article investigates the construction of medical knowledge and practice in gynecology and obstetrics. Specifically, it focuses on the transformations of social and medical meanings in the pregnant body that occurred since the end of the 19th century and during the 20th century, and which make possible the process of medicalization, pathologization and hospitalization of childbirth. Likewise, the effects that the technocratic medical model of care for the pregnancy / childbirth binomial has in terms of the experience of these processes in women are explored; concluding on the need to deepen the elements of the medical paradigm, the training of health professionals and the working conditions in the health sector that intervene in the problem of dehumanization of care.

Resumo Este artigo investiga a construção do conhecimento e da prática médica em ginecologia e obstetrícia. Especificamente, concentra-se nas transformações dos significados sociais e médicos no corpo gestante ocorridas desde o final do século XIX e durante o século XX, e que possibilitam o processo de medicalização, patologização e hospitalização do parto. Da mesma forma, são explorados os efeitos que o modelo médico tecnocrático de atenção ao binômio gravidez / parto tem em termos da experiência desses processos em mulheres; concluindo sobre a necessidade de aprofundar os elementos do paradigma médico, a formação dos profissionais de saúde e as condições de trabalho no setor da saúde que intervêm no problema da desumanização da assistência.

Asexual-Identified Adults: Interactions with Health-Care Practitioners.

Historically, people with minority sexual and gender identities (e.g., gay, lesbian, bisexual, transgender) have been pathologized by mental and medical health practitioners. The potential for pathologization of asexuality is particularly salient considering a lack of sexual desire or interest has been studied in relationship to depression, antidepressant medication, and hypothyroidism. To explore this potential pathologization, asexual individuals were asked about their interactions with mental health and medical practitioners. The study included 136 adult participants, primarily from the U.S., who self-identified as asexual. Participants completed an online survey which contained questions about their experiences with mental health and medical practitioners. Results indicated that the majority of participants did not disclose their identity and felt uncomfortable discussing issues related to sexuality with their providers. Participants were more likely to disclose their asexual identity to mental health providers, as compared to medical providers. Participants who had positive experiences were more likely than those who had negative experiences to indicate that their practitioners were familiar with asexuality, accepted the participant's identity completely, and reacted to the disclosure in a positive and affirming manner. Positive experiences included practitioners educating themselves about asexuality, while negative experiences included practitioners disbelieving the existence of asexuality, and between one quarter and one half of participants reported that practitioners attributed their asexuality to a health condition. The findings from this study demonstrate the importance of including information about asexual identities in health education and ongoing diversity training in order to increase the cultural sensitivity of health practitioners.

Is ugliness a pathology? An ethical critique of the therapeuticalization of cosmetic surgery.

Pathologizing ugliness refers to the framing of unattractive features as a type of disease or deformity. By framing ugliness as pathology, cosmetic procedures are reframed as therapy rather than enhancement, thereby potentially avoiding ethical critiques regularly levelled against cosmetic surgery. As such, the practice of pathologizing ugliness and the ensuing therapeuticalization of cosmetic procedures require an ethical analysis that goes beyond that offered by current enhancement critiques. In this article, I propose using a thick description of the goals of medicine as an ethical framework for evaluating problematic medical practices. I first describe the goals of medicine based on Daniel Callahan's account. I then propose that the goals work best in conjunction with ancillary ethical concepts, namely medical knowledge and skills, standards of practice and medical duties and virtues. Next, I apply the thick description of the goals of medicine in critiquing the practice of framing ugliness as disease. Here, I demonstrate ethical conflicts between aesthetic judgments that underpin the practice of pathologizing ugliness and medical judgments that inform ethical medical practices. In particular, the thick description of the goals of medicine helps reveal ethical conflicts in at least three key domains common to clinical practices, which include (a) disease determination, (b) diagnostic evaluation and (c) establishing clinical indications. My analysis offers a novel way of critiquing the practice of pathologizing ugliness in cosmetic surgery, which tends to be neglected by enhancement critiques.