Afasta de mim esse cale-se: a medicalização na vida de pessoas usuárias de um CAPS AD

Abstract

The history of drugs has come a long way until drugs were understood as a social phenomenon. The “evil of humanity”, as they have been thought in so many moments - when dealing, of course, with illicit ones – is seen as a serious public health problem and as a constant political and social challenge – yet there are other lenses that are used to see this question: lenses of morality, lenses of religiosity, lenses of criminality. From “war on drugs” discourse, practices, scarcely non-violent, are made possible, and used to legitimize a hate regime that violates rights, undermines modes of existence, and poses obstacles for the possibilities of care, reception and production of autonomy. In Brazil, the Anti-asylum movement, advancements of the Psychiatric Reform, and the approval of Law 10.216/2001 have forced the creation of substitutes for asylum-based services. Psychosocial Care Centers for Alcohol and Other Drugs (CAPSad) are among such substitutions, whose work is to offer daily assistance to people who binge drink alcohol and “problematically” use other drugs, building unique therapeutic reception plans mandatorily based, until very recently, on Damage Reduction (DR) strategies. Such services, however, have faced constant attacks, making up the list of setbacks to which Brazilian mental health has been harshly subjected. Despite of what was described and proposed, substitutive services still deal with the challenge of overcoming therapeutic strategies inherited from the hospitalocentric model. Medicalization still presents itself as the main strategy adopted in the services that make up the Psychosocial Care Network (RAPS). Such services are crossed by medicalizing practices and do not seem to strain this reality. Thus, we have to consider medicalization of life beyond the criticism of medical knowledge and the abusive prescription of medicines so that we can understand it as a game of forces whose participants are, among others, Institutions, Industries, the State and society itself. Thereby, the present dissertation work aims at understanding how medicalization is inscribed in the lives of people who use CAPSad II in Campina Grande, in the State of Paraiba. In order to reach this purpose, we have adopted the following specific objectives: I) to analyze how users construct their own identity positionings and how these positionings are linked to medicalization; II) to understand the place that medication takes in the care processes of CAPSad II users; and III) to identify the meanings produced by the medicalization process. To meet these objectives, we are, theoretically and methodologically, based on the study of the production of meanings from the analysis of discursive practices and the language in use (M. J. Spink, 2010a). Considering the qualitative nature of this research, participant observation was performed in the theme field and, subsequently, discourse analysis of field diaries was carried out. So that it was possible to understand how medicalization is inscribed not only in the care and “treatment” processes, but in life experiences that, though reported during activities at CAPSad II, go through the medicalizing sieve that makes up people's daily lives. Findings show that meanings constructed by medicalization place people and define them, for example, indicating whether or not they are fit for the job market; they legitimize the violation of rights, and define how people are positioned by family members and neighbors, and whether or not they will have a place to live – taking into account the presence or absence of abstinence; as well as affective relationships that may or may not be experienced. "Treatment" is usually seen as a kind of script to be followed and as a prerequisite for reintegration into a social gear that does not allow deviations. So, in general, medicalization proved to be present in identity positionings such as in those of people using CAPSad II. For instance, they usually describe themselves as being "problematic", "helpless", "unreliable", "aggressive", "aimless", "hopeless", "troublesome" – positionings that are legitimized by medical, moral, religious, and legal discourses, all components of the same phenomenon, and perpetuated in social imagination. However, as possible rupture/resistance against stigmatization, people describe themselves as “good/kind”, “calm”, “winners”, “apt for work”. Regarding medicalization in the care processes, we identified that it plays a central role. The prescription and use of medications proved to be a determining factor in the service. "Dependence" and "control" relations operated by psychiatric drugs, maintenance of "stability" and side effects relations were aspects that emerged. The decrease in use, a possible withdrawal, as well as the search for conditions for handling daily issues also emerged. Based on ruptures that came up during the analyses, we believe that we can invest collective strength into the work and into the fight for the implementation of public policies that promote health through guaranteeing access to education, housing, food, leisure, among other rights that, like these, speak of “(unique) health needs”.