Psychiatry and Politics in Pelotas, Brazil:

Abstract

The world-wide emergence of categories for diagnosing mental health problems in children and youth such as conduct disorder is often attributed to the globalization of a highly biomedical form of psychiatry. In Brazil, a small group of therapists are resisting biomedicalization by keeping psychodynamic traditions alive and aiming to transform psychotherapy into a resource for politicized youth empowerment. Nevertheless, clinical practices demonstrate an increased use of biomedical diagnoses and therapeutic routines. On the basis of fieldwork with therapists and teachers, and a nine-year-long ethnography of young people, this article explores the localized effects of these potentially contradictory developments. Results show that the growth of biomedical practices alongside politicized therapeutic approaches is not indicative of underlying ambiguities but has, rather, emerged from the purposefully equivocal nature of Brazilian social, medical, and professional life. The article uses this Brazilian case study to critically debate theories of medicalization in the anthropology of psychiatry.

Contraceptive medicalisation, fear of infertility and teenage pregnancy in Brazil

“…These women defied belonging to either a ‘traditional’ and ‘modern’ ideology; they were identified by others in their community as being ‘traditional’ because they valued, first and foremost, their role as young mothers. At the same time, they were modern because they engaged in highly politicised debates about the limitations of the educational system and the discriminatory power of inappropriate stereotypes regarding teenage mothers, despite the added risk of pathologization that this entailed ( Béhague 2009 ). Indeed, the stereotype of the ‘reproductively prolific’ lower-class woman was sometimes, in hindsight, even adopted in jest as a way of resisting inappropriate but widely-held conceptualisation of the poor.…”

Taking pills for developmental ails in Southern Brazil: The biologization of adolescence?

“…Importantly, this explanatory model also fails to account for the role of economics, structure, pragmatism and patience, the complex multi-institutional support systems that enable success stories such as Juliane's. As I have described elsewhere, some of these success stories occurred in the context of deep commitment to a consideration of ‘the social’ as both etiologically and therapeutically central, and they did not always engender a vindicating anti-biologizing psychodynamic posture ( Béhague, 2009 ).…”

“…Thus, the very use of this explanatory model must be included as one among other social, economic, moral forces accounting for the emergence of chronic and stagnating biotherapeutic forms, the very kind of “local biology” ( Lock, 1995 ) therapists wish to avoid. This is not a gratuitous critique, for this same Pelotense world provides us with exemplary moments in which the impetus for a personally and socially transformative therapeutic form is realized, often against considerable odds ( Béhague, 2009 ). And, though Pelotas appears to be comprised of a unique epistemic tradition, it is very likely that even in corners of the world where biopsychiatry is more entrenched, a polarizing for-or-against positionality vis-à-vis biopsychiatry also conceals broader ethical challenges at stake in pharmaceuticalization.…”

“…He had a niggling sense that in her case, prolonged medication-use had dulled her, worsened her symptoms. And the search for an alternative therapeutic trajectory did not seem – and indeed was not – completely unrealistic ( see Béhague, 2009 for a description of these alternatives). Her life situation had actually improved somewhat; with full support from her mother, she was managing to sustain a regular work schedule while still caring for her daughter.…”

Adolescent Sex and Psyche in Brazil: Surveillance, Critique and Global Mental Health

“…That some young people sought to discuss these issues with not just anyone but with a therapist whom they viewed as a representative of the elite was highly significant. As I have shown elsewhere, what ensued was productive in part because of therapists’ willingness to make of the clinical encounter a space of social conflict, of the rendering accountable of those in power, and through this, of addressing young women’s moral and political worthiness (Béhague 2009).…”