Utilização do diagnóstico em saúde mental : a percepção de usuários e familiares de um centro de atenção psicossocial

Abstract

The general goal of this research study is to understand which senses and meanings patients and relatives give to the diagnosis of mental disorders, and how this diagnosis impacts on their histories, living, and daily lives. This question lays on the Psychiatric Care Reform theoretical and conceptual dimensions, as it discusses aspects related to Psychiatry fundamental concepts. The Psychiatric Care Reform movement is marked by by the coexistence of two models in the practice of professionals who act in the care of mental health patients. Therefore, it is important to discuss and to question how the device of diagnosis, imported from the biomedical model, is used in the context of overcoming stigma and social exclusion of users who benefit from the psychosocial care model. It is a qualitative study, exploratory, in which we performed 14 semi-structured interviews, being seven with users and the other seven with their correspondent relatives, all of whom were bounded to a Psychosocial Care Center (CAPS), type II, from a city of the surrounding areas of Porto Alegre, Brazil. The participants' selection happened during the researcher's meetings with the Center's technical staff. We selected users who had been bounded to the CAPS for one year or more, as we assumed the existence of a bonding with the reference staff after such period of time. We also estimated that the staff would have reasonable knowledge to establish a diagnosis or a diagnostic hypothesis after one year of bonding. Therefore, we assumed the users could have a more critical opinion regarding their mental health care processes. We asked that the chosen relative to be someone who checks up on the user closely at the Center. The interview script approached the following topics: understanding on the beginning of getting sick; ways of accessing the health network and other public or private care units; daily life, and community and social experiences; relationship with CAPS and with staff; meaning given to diagnosis and to the received treatment; perceptions of changes after getting sick and diagnosis. The interviews were recorded and then transcribed. The data analysis methodological path of this research study was conducted with Discursive Psychology, having Social Constructionism as its epistemological basis. We performed the analysis in order to identify the interpretative repertoires which, according to Potter and Wetherell (1987), are marked by clusters of terms, metaphors, idioms and vivid images that are used in conversation. We identified interpretative repertoires that originated the following cores of analysis: 1) Meanings given to the process of getting sick and to the concept of normality; 2) Approach to diagnosis in the psychosocial care model; 3) Giving new meanings to getting sick: changing and finding new possibilities of living. The use of interpretative repertoires made it possible to understand that users have their possibilities of living limited by the presence of a normative and biomedical logic in their community experiences, which contributes to their experiencing of stigma and social exclusion. This way of thinking is crossed by a mental health care that, at times, is marked by the lack of dialogue among professionals, users, and relatives, regarding both the diagnosis itself and other crossings that are part of the process of getting sick. However, the positive point of view of users and relatives about the CAPS points to its importance as a place of constructing a mental health mentality that promotes citizenship, autonomy, and that sees the sick individual as from their desires and capabilities.