O DSM como ideologia: uma crítica do Manual Diagnóstico e a luta paradigmática em Saúde Mental
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Data
2020-09-01
Autores
Passarinho, José Guilherme Nogueira
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
A quinta edição do Manual Diagnóstico e Estatístico de Transtornos Mentais DSM-5 é comumente tomada como uma nomenclatura oficial para os diagnósticos psiquiátricos. Trata-se de um documento capaz de influenciar decisivamente a prática cotidiana de inúmeros trabalhadores do campo da Saúde Mental e de mudar a vida das pessoas rotuladas com suas categorias diagnósticas. Contudo, essas afirmações contrastam com uma série de críticas feitas por uma diversidade de pesquisadores e profissionais do campo em questão, tanto na época do lançamento do Manual quanto nos anos posteriores. O objetivo do presente estudo é investigar a inserção do DSM nas instituições públicas de Saúde Mental em nosso país, alguns de seus efeitos e consequências, servindo-nos, para tanto, dessa tensão existente entre os apologéticos enunciados oficiais e as numerosas críticas feitas ao Manual, além dos referenciais teóricos escolhidos. Como forma de contribuir para tal discussão, pretendemos esboçar uma nova crítica, baseada no conceito marxista de ideologia. Assim, o leitor encontrará quatro ensaios apoiados em um referencial teórico-epistemológico principal, o materialismo histórico, ainda que articulado com reflexões e categorias emprestadas da psicanálise do campo de Freud e Lacan. O primeiro ensaio se dedica a contextualizar o campo das instituições brasileiras de Saúde Mental, em que encontramos dois modos paradigmáticos antagônicos e em luta pela hegemonia. O segundo busca fazer uma incursão teórica sobre o conceito de ideologia, no qual fazemos uma aposta para compreendermos um pouco melhor o DSM e seu funcionamento. O terceiro pretende realizar uma revisão sobre algumas das principais publicações científicas acerca do Manual, como forma de nos familiarizarmos com as discussões e nos prepararmos para dar nossa própria contribuição. E o quarto ensaio é onde todos os anteriores são articulados, em que argumentamos sobre a pertinência em compreender o DSM a partir do conceito de ideologia como uma importante chave de leitura. Concluímos que o funcionamento do DSM e da psiquiatria que lhe é correlata podem ser descritos como ideológicos, sendo a sua superação uma condição necessária para que uma forma radicalmente outra de produzir Saúde Mental seja possível.
The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders DSM-5 is commonly taken as an official nomenclature for psychiatric diagnoses. It is a document capable of decisively influencing the daily practice of countless workers in the field of Mental Health and also capable of changing the lives of people labeled with their diagnostic categories. However, these statements contrast with a series of criticisms made by a diversity of researchers and professionals in this field, both at the time of Manual release and in subsequent years. The objective of the present study is to investigate the insertion of the DSM in the public institutions of Mental Health in our country, some of its effects and consequences, using, for this purpose, the tension between the apologetic official statements and the numerous criticisms made to the Manual in addition to the chosen theoretical frameworks. As a way of contributing to such discussion, we intend to outline a new criticism, based on the marxist concept of ideology. Thus, the reader will find four essays based on our main theoreticalepistemological framework, historical materialism, although articulated with reflections and categories borrowed from freudian and lacanian psychoanalysis. The first essay is dedicated to contextualizing the field of Brazilian Mental Health institutions, where we can find two antagonistic paradigmatic modes in a struggle for hegemony. The second seeks to make a theoretical foray into the concept of ideology, in which we make a bet to understand a little better the DSM and its functioning. The third intends to carry out a review on some of the main scientific publications about the Manual, as a way to familiarize ourselves with the discussions and prepare to make our own contribution. And the fourth essay is where all the previous ones are articulated, in which we argue about the pertinence in reading DSM having the concept of ideology as an important key to understand it. We conclude that the functioning of the DSM and its correlate psychiatry can be described as ideological, and its overcoming is a necessary condition for a radically different way of producing Mental Health to be possible.
The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders DSM-5 is commonly taken as an official nomenclature for psychiatric diagnoses. It is a document capable of decisively influencing the daily practice of countless workers in the field of Mental Health and also capable of changing the lives of people labeled with their diagnostic categories. However, these statements contrast with a series of criticisms made by a diversity of researchers and professionals in this field, both at the time of Manual release and in subsequent years. The objective of the present study is to investigate the insertion of the DSM in the public institutions of Mental Health in our country, some of its effects and consequences, using, for this purpose, the tension between the apologetic official statements and the numerous criticisms made to the Manual in addition to the chosen theoretical frameworks. As a way of contributing to such discussion, we intend to outline a new criticism, based on the marxist concept of ideology. Thus, the reader will find four essays based on our main theoreticalepistemological framework, historical materialism, although articulated with reflections and categories borrowed from freudian and lacanian psychoanalysis. The first essay is dedicated to contextualizing the field of Brazilian Mental Health institutions, where we can find two antagonistic paradigmatic modes in a struggle for hegemony. The second seeks to make a theoretical foray into the concept of ideology, in which we make a bet to understand a little better the DSM and its functioning. The third intends to carry out a review on some of the main scientific publications about the Manual, as a way to familiarize ourselves with the discussions and prepare to make our own contribution. And the fourth essay is where all the previous ones are articulated, in which we argue about the pertinence in reading DSM having the concept of ideology as an important key to understand it. We conclude that the functioning of the DSM and its correlate psychiatry can be described as ideological, and its overcoming is a necessary condition for a radically different way of producing Mental Health to be possible.
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Palavras-chave
DSM., Ideologia., Saúde Mental., Psiquiatria., Diagnóstico.