Reflexiones nerviosas. Los fantasmas / Reflections nerve. The ghosts

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Psychiatric collaborations in the Hispanic world / Colaboraciones en psiquiatría en el mundo hispánico

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Biopolíticas, gobierno y salud pública: miradas para un diagnóstico diferencial / The biopolitics, government and public health: perspectives for differential diagnosis

Desde que Michel Foucault diera inicio a la serie de investigaciones que toman la biopolítica como categoría de análisis, la pregunta por la vida y por el poder se anudan inextricablemente. En ello, la problemática de la salud se vuelve decisiva. De hecho, en 1974 la noción de biopolítica designa la arremetida de una medicina social que contribuía a la normalización y regulación de los modos de vida. La preocupación médica, en su vertiente sanitaria, acude a la conformación de la población como objeto de gobierno privilegiado para el biopoder.A esta luz, el presente libro pretende hacer dialogar las discusiones filosóficas con el distrito heterogéneo de los salubristas, quienes aportan una mirada médica que refresca -con preguntas que arrancan del ejercicio efectivo de la salud pública-, la revisión teórica y el refinanciamiento conceptual. Por esta razón, los artículos que aquí se presentan están atentos a los cruces e interferencias que la biopolítica pueda tener con la política pública de salud y con la historia sanitaria de nuestros países. Es esta enigmática confluencia la que anima las reflexiones que siguen: ¿Cómo y bajo qué pretexto podría ser oportuno un diálogo entre biopolítica y salud pública? Los textos aquí reunidos se proponen avanzar en dos direcciones que toman como inicio la noción de biopolítica. En Inconclusiones de vida. Discusiones teórico–filosóficas, se lleva a cabo una revisión crítica que ponen en forma algunas precisiones que comportan los desarrollos teóricos de algunos autores que se han servido de la categoría. Por otra parte en Tratamientos irresolutos: Población, medicinas y salubridad, se dan cita algunos ejercicios analíticos provenientes del ámbito de la salud pública y que toman la noción de biopolítica como insumo teórico para sus propuestas...

[Biologism controversy: ethical implications for psychiatry]. / Biologismus-Kontroversen: Ethische Implikationen für die Psychiatrie.

Current biological psychiatry, it is frequently claimed by its opponents, is "biologistic" and unduly narrows psychological disorders to neurobiology and molecular biology. They deem a complete neuroscientific reduction of the mental phenomena to be impossible because of the impossibility of reducing certain phenomena, such as the individual subjective experience. If such a reduction is nevertheless undertaken it is ultimately to the disadvantage of the patients. We argue in this article that the very term "biologism" has to be put under scrutiny in the first place. As a result it becomes obvious that "biologism", as a subclass of "philosophical naturalism", is ultimately quite unproblematic. Biologism is dangerous only if it implies an eliminative rejection or an inappropriate underestimation of the relevance of the psyche. On closer examination it gets evident that such implications do not follow necessarily from biologism but cannot be precluded either. To better identify and possibly prevent such dangers, a more differentiated terminology seems helpful.

Reflexiones nerviosas: La importancia de la ropa (II). Lencería, complementos y zapatería / Nervous reflections: Clothing prominence (II): Lingerie, accessories and footwear

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Partnering with children diagnosed with mental health issues: contributions of a sociology of childhood perspective to participatory action research.

This paper explores the use of participatory action research (PAR) with children diagnosed with mental health issues. We argue that critiques from the sociology of childhood are useful for guiding PAR with children. First, we describe and critique values and assumptions that underlie research and practice with children who experience mental health issues. Second, we outline key qualities of the sociology of childhood, discuss their implications for PAR with children diagnosed with mental health issues, and touch on ethical issues. Five themes are explored: (a) values, (b) ontology/epistemology, (c) views about children, (d) agency/power in children's relationships with adults, and (e) intervention/change focus. We conclude by encouraging community psychologists to consider PAR with children diagnosed with mental health issues.

Ethics in contemporary community psychiatry.

Community psychiatry is a wonderful and rewarding career path that increasing numbers of psychiatrists are choosing to practice.14 This article was created to provide an orientation to the characteristics of contemporary community psychiatric practice that render it distinct in terms of ethical considerations. We defined and described community practice. We provided a framework based on classical medical ethics that can be used to consider challenges in particular community practice situations. We also offered special considerations of key areas in which community practice demands novel treatment methods coupled with special clinical expertise in assessing risks and benefits. We hope to have provided a discussion that supports a broadening of existing psychiatric ethical guidelines so that they are inclusive of the kinds of situations routinely encountered by community psychiatrists and other community mental health care professionals and paraprofessionals. It is our hope that ideas presented in this article will help to equip psychiatrists and their community teams to facilitate the successful rehabilitation and recovery of the individuals they serve.

Política de atenção ao indivíduo em sofrimento mental em um município do oeste do Paraná / Policy attention to individuals with mental suffering in a western city of Paraná

A assistência psiquiátrica a indivíduos com sofrimento psíquico, em seu campo político, passou por um longo processo de discussão e formulação de estratégias a fim de garantir condição de humanidade aos indivíduos assistidos. A Reforma Psiquiátrica brasileira, como ficou conhecida, ocorreu concomitante ao processo de Reforma Sanitária e formulou leis para a garantia da integralidade e do acesso universal à saúde em território nacional sob a responsabilidade das esferas governamentais. No município de Cascavel – PR, o processo de formulação das políticas assistenciais para o indivíduo com transtorno mental se inicia na década de 90, porém só é efetivamente estruturado a partir de 2003 com o fechamento do Hospital Psiquiátrico São Marcos, que forçou o município a agilizar o processo de implantação da rede assistencial e de serviços complementares com moldes psicossociais. Com isso o município estrutura a assistência ao portador de transtorno mental através da implantação de ambulatório especializado, serviço de urgência e centros de atenção psicossocial para adultos, crianças e usuários de álcool e outras drogas, todos estruturados com suporte assistencial realizado pela Unidade Básica de Saúde (UBS). Em cada UBS foi nomeado um profissional de referência para o acompanhamento desses usuários e de seus familiares com o intuito de fortalecer o vínculo e manter a relação entre os serviços complementares e atenção primária. O presente estudo é centrado na pesquisa bibliográfica e de campo, com caráter qualitativo, cujo ponto de partida é a coleta de dados por meio de aplicação de questionário semi-estruturado com a finalidade de conhecer o processo de formulação das políticas municipais de atenção ao doente mental através do questionamento sobre as práticas assistenciais desenvolvidas pela atenção primária à saúde...

The psychiatric care to individuals with psychological distress, based on its political area, went through a long process of discussion and formulation of strategies to ensure human condition for assisted individuals. Psychiatric Reform in Brazil, as it was known, happened concomitantly with the Sanitary Reform and stated laws to guarantee the completeness anduniversal access to health in the country under the responsibility of the civil cabinet. In the city of Cascavel, Paraná State, the process of formulating welfare policies for individuals withmental illness has started in the 90s, but, it is only effectively structured up from 2003, when São Marcos Hospital was closed. This forced the municipality to expedite the implementing process concerning the care network and additional services with psychosocial patterns. Thus, the municipality structures assistance to the ones who were mentally ill through theimplementation of an outpatient clinic, emergency department and psychosocial care centers for adults, children and users of alcohol and other drugs, all structured to support careconducted by the Basic Health Unit (BHU). In each BHU, it was designated a professional of reference for the monitoring of users and their families in order to strengthen the bond and keep the relationship among complementary services and primary care. This study is focused on literature and field research, with qualitative approach, whose starting point is the collection of data through the application of semi-structured questionnaire in order to know the process for formulation of municipal policies to mental patient care through the questioning of care practices developed by primary health care.

[Socialpsychiatric and ethical reflections about prevention of schizophrenic disorders]. / Sozialpsychiatrische und ethische Uberlegungen zur Prävention schizophrener Störungen.

PROBLEM: In the last years there has been a shift from curative to preventive objectives in politics (prevention law) and medicine, by which socialpsychiatric practice also is affected. This requires a critical reflection about ethical, methodical and therapeutic problems of the prevention of psychological disorders--especially schizophrenic psychosis. ARGUMENTS: Studies dealing with the prodromal stage of schizophrenia point to a successful early detection and intervention. But also negative consequences like stigmatization and side effects by psychotherapeutic or pharmacologic interventions should be taken into account. CONCLUSION: Under critical consideration of the ethical principles of not causing harm, acting for the well-being and the person's right of self-determination prevention should play a larger role in psychiatry. Therefore further empirical studies about the efficacy of early detection and intervention are needed.

Aspectos éticos en la práctica de la psiquiatría comunitaria / Ethic Aspects in Community Psychiatric Practice

El entorno comunitario resulta el idóneo para la atención a las personas que sufren trastornos mentales. Corresponde a los centros comunitarios de salud mental, mediante los equipos básicos de trabajo, garantizar que esta atención sea lo óptima que se requiere, para así disminuir la frecuencia de ingresos en hospitales psiquiátricos, y lograr que cuando sea necesaria la hospitalización, esta sea por el menor tiempo posible. El respeto a la integridad, la dignidad y el decoro del paciente psiquiátrico y de sus familiares, pero también la educación de los miembros de la comunidad a la que pertenecen los primeros, tendrá que ser motivo de revisión constante para que se consigan realmente los objetivos propuestos. La práctica de la Psiquiatría comunitaria impone nuevos retos en lo que respecta a ética médica. La conducta suicida requiere un manejo especializado, del mismo modo que el paciente alcohólico o drogadicto, el que sufre un trastorno psicótico, o el que es víctima de violencia en su seno familiar, por solo mencionar algunos casos. Se revisan estas y otras situaciones tales como el ingreso domiciliario y en taller protegido, las visitas de terreno e incluso algunas actividades docentes e investigativas que tendrán que ser concebidas con el prisma de la más rigurosa ética por parte del equipo de salud mental. También se incluyen ciertas reflexiones acerca de las acciones para dar cumplimiento a algunos de los programas de la salud mental(AU)

Community environment is the most competent for the attention for the attention of people suffering from mental disorders. Community Health Centers are the ones that should guarantee the quality of this attention, so as to diminish patients frequency of admission in psychiatric hospitals, and if admission is needed, it should be for a short period of time. This work is carried out by means of basic working teams. The respect to integrity, dignity and honor of psychiatric patients and their family, as well as the community members education patients belong to should be controlled systematically in order to achieve t h e intended objectives. Community Psychiatry Practice arouses new challenges with regard to medical ethics. Suicide behavior, alcoholic or drug addict patients, people suffering from psychiatric disorders, or those who are victims due to family violence, among others, required a specialized treatment. These and other situations such as home and protected workshop admission, home visits to patients and even some investigations and teaching activities which must be conceived taking into account the most rigorous ethics on the part of the mental health team are analyzed. Some reflections about actions to accomplish some mental health programs are also included(AU)

Aspectos éticos en la práctica de la psiquiatría comunitaria / Ethic Aspects in Community Psychiatric Practice

El entorno comunitario resulta el idóneo para la atención a las personas que sufren trastornos mentales. Corresponde a los centros comunitarios de salud mental, mediante los equipos básicos de trabajo, garantizar que esta atención sea lo óptima que se requiere, para así disminuir la frecuencia de ingresos en hospitales psiquiátricos, y lograr que cuando sea necesaria la hospitalización, esta sea por el menor tiempo posible. El respeto a la integridad, la dignidad y el decoro del paciente psiquiátrico y de sus familiares, pero también la educación de los miembros de la comunidad a la que pertenecen los primeros, tendrá que ser motivo de revisión constante para que se consigan realmente los objetivos propuestos. La práctica de la Psiquiatría comunitaria impone nuevos retos en lo que respecta a ética médica. La conducta suicida requiere un manejo especializado, del mismo modo que el paciente alcohólico o drogadicto, el que sufre un trastorno psicótico, o el que es víctima de violencia en su seno familiar, por solo mencionar algunos casos. Se revisan estas y otras situaciones tales como el ingreso domiciliario y en taller protegido, las visitas de terreno e incluso algunas actividades docentes e investigativas que tendrán que ser concebidas con el prisma de la más rigurosa ética por parte del equipo de salud mental. También se incluyen ciertas reflexiones acerca de las acciones para dar cumplimiento a algunos de los programas de la salud mental(AU)

Community environment is the most competent for the attention for the attention of people suffering from mental disorders. Community Health Centers are the ones that should guarantee the quality of this attention, so as to diminish patients’ frequency of admission in psychiatric hospitals, and if admission is needed, it should be for a short period of time. This work is carried out by means of basic working teams. The respect to integrity, dignity and honor of psychiatric patients and their family, as well as the community members’ education patients belong to should be controlled systematically in order to achieve t h e intended objectives. Community Psychiatry Practice arouses new challenges with regard to medical ethics. Suicide behavior, alcoholic or drug addict patients, people suffering from psychiatric disorders, or those who are victims due to family violence, among others, required a specialized treatment. These and other situations such as home and protected workshop admission, home visits to patients and even some investigations and teaching activities which must be conceived taking into account the most rigorous ethics on the part of the mental health team are analyzed. Some reflections about actions to accomplish some mental health programs are also included(AU)

Modos de subjetivação dos trabalhadores de saúde mental em tempos de Reforma Psiquiátrica / Modes of subjectification of mental health workers in the context of the Psychiatric Reform

O artigo discute os modos de subjetivação dos trabalhadores de saúde mental no contexto da Reforma Psiquiátrica. A partir da revisão da literatura, da análise de documentos e de 40 entrevistas com trabalhadores de serviços de saúde mental, busca analisar, por meio da utilização das ferramentas teóricas construídas por Michel Foucault, os jogos de verdades e os desafios e dificuldades presentes na implementação dos princípios da Reforma Psiquiátrica. Aponta para o jogo político e a disputa em torno das verdades sobre as formas de atenção, assim como para a necessidade de reflexão permanente com relação às formas de implicação com o trabalho como forma de evitar o adoecimento dos trabalhadores.

The article discusses the modes of subjectification of mental health workers in the context of the Psychiatric Reform. Based on the scientific literature review, document analysis and 40 interviews with mental health services workers, we intended to analyze, using the theoretical tools constructed by Michel Foucault, the truth games, challenges and difficulties present in the implementation of Psychiatric Reform's principles. We describe the political games and the dispute around the truth about the forms of health attention, as well as the need of permanent reflexive attitude towards work implication in order to avoid occupational diseases on workers.

A alteridade no discurso da Reforma Psiquiátrica brasileira face à ética radical de Lévinas / Alterity in the brazilian Psychiatric Reform discourse in view of Lévinas's radical ethics

Este artigo trata das premissas éticas da Reforma Psiquiátrica, mais especificamente, da desinstitucionalização enquanto desconstrução, a partir do pensamento de Emmanuel Lévinas, e a concepção de alteridade postulada a partir da proposta de uma ética radical. O resgate dos pressupostos éticos da Reforma Psiquiátrica, considerados sob novos enfoques teóricos, pode contribuir para desvelar e compreender os diversos caminhos que esse processo vem tomando com a diversidade de práticas em construção e a disseminação de serviços substitutivos em saúde mental.

This paper deals with some ethic premises of the Psychiatric Reform, more specifically, with desinstitutionalization as deconstruction, establishing a dialogue with the ideas of Emmanuel Lévinas. The concept of alterity is considered at the interface of radical ethic included in this approach. The discussion points out that the incorporation of ethical premises from the Psychiatric Reform can help understand the different possibilities and social consequences of this process, considering the diversity of practices being constructed and the growing of substitutive services in the Mental Health field.