“Outrar-se” sujeito: autonomia e sentidos construídos por usuários/as do CAPS III de Campina Grande/PB

Abstract

The Brazilian Psychiatric Reform and the Anti-Asylum Movement marked a paradigm change in mental health care, shifting the focus from illness to the subject experiencing psychological distress and their community and territorial relationships. The Singular Therapeutic Project (PTS, in Portuguese), is an important instrument in this process, as its formulation is based on care in freedom and the encouragement of user’s participation and autonomy, enabling the consolidation of a new form of mental health care. This study investigated how users of the Psychosocial Care Center III (CAPS III) in Campina Grande-PB exercise their autonomy through the narratives constructed about their daily activities. The specific objectives were to find out, through the narratives, if autonomy is being encouraged at CAPS III by applying PTS construction processes; to analyze the meanings that CAPS III users construct about their participation in this therapeutic project; and to analyze the identity positions they construct in their narratives. It is a qualitative research of an exploratory nature, based on the theoretical-methodological perspective of the study of meaning production through the analysis of discursive practices. To gather information, a “photography workshop” device and a field journal were used. Eleven workshops were conducted and had audio recorded. Five service users – one man and four women – participated in these workshops. The narratives produced in the workshops were subjected to discourse analysis using dialogic maps. Participants position themselves as capable of exercising their autonomy, despite social limitations such as lack of credibility and access to work. The narratives highlight the centralization of medicalization and its detrimental effects, suggesting the importance of autonomous medication management. Actions that restrict autonomy were identified, such as the risk of guardianship, discrimination, and stigma, as well as actions that encourage autonomy through social support from family and mental health services. There was evidence of unfamiliarity with the term ‘Singular Therapeutic Project’ and a lack of encouragement for subjects autonomy in choosing the activities they will develop in the service. By positioning themselves as capable individuals, they value freedom and independence and refuse to be classified as “crazy” or “sick” people. The study concludes that, even in the face of societal constraints, users of this service resist and strive to exercise autonomy and affirm their capabilities.