From Person to Life: An Anthropological Examination of Primary Health Care Approach to Depression in Rio de Janeiro

Abstract

Mental illness approaches in public health have resulted in controversies around the adequacy of interpretative and therapeutic models. These controversies engage polarized debates amid understandings of mental illnesses either as brain disorders or as socioculturally determined entities. Aiming to investigate how mental health care is implemented in a Latin American metropolis, we conducted an ethnographic study of the approach to depression in a primary care unit in Rio de Janeiro between 2016 and 2017. "Life" emerged from our fieldwork as the main local category for understanding the experiences of patients with depressive symptoms and the work of reengagement performed by family physicians. With this investigation, we seek to provide insights into an approach to mental illness in primary health care that moves away from polarized interpretive frameworks and remains open to the singularities of patients' experiences of suffering. [Brazil, depression, life, reparative ethnography] "Francisca, go on living." (Jaime, family medicine resident) "No, I won't go on living." (Francisca, after her son was killed by the police) 64

The politicizing clinic: insights on ‘the social’ for mental health policy and practice

“…Young people who returned to the clinic, despite intense feelings of disappointment and mistrust, used the therapeutic encounter to engage in social and political debate and explore new modes of agency. Clinical interactions came to center not on treatment of disorder or symptom-reduction, but on crafting self-worth, political awareness, and social influence [ 45 ]. What seems to have made a difference for young people were therapists who responded flexibly, recognized the limits of their own positionality, and maintained dialogic openness to unstructured reflection and the productivity of confrontation.…”

Entre “centrado na pessoa” e “freestyle”: a abordagem do sofrimento mental comum em residências de medicina de família e comunidade

“…(RB1) Resumimos, no Quadro 3, as abordagens relatadas pelos residentes, assinalando se o entrevistado apenas conhecia a intervenção ou se afirmou utilizá-la em sua prática ao atender pessoas com SMC. Como evidenciado no Quadro 3, a única abordagem citada por todos os residentes foi a aplicação do método clínico centrado na pessoa (MCCP), provavelmente por ser um paradigma clínico particular da especialidade 25 considerada uma competência essencial para os médicos de família e comunidade 19 e muito difundida e abordada entre os PRMFC, livros 15,26 e congressos da especialidade. Observamos que MCCP não foi citado pelos residentes como paradigma clínico geral da especialidade, mas como uma técnica específica a ser utilizada em algumas situações.…”