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

Abstract

In the late 1990s researchers in Pelotas Southern Brazil began documenting what they considered to be unacceptably high rates of licensed psychotropic use among individuals of all ages, including youth. This came as a surprise, since the vast majority of psychiatrists in Pelotas draw on psychoanalytic theory and approach pharmaceutical use, especially for children and adolescents, in a consciously tempered way. Drawing from a longitudinal ethnographic sub-study, part of a larger 1982 birth cohort study, this paper follows the circuitous trajectories of emergent pharma-patterns among “shantytown” youth over a ten-year period, exploring the thickly layered and often moralized contingencies in which psychodynamic psychiatrists' intention to resist excessive pharmaceuticalization both succeed and crumble. I juxtapose these trajectories with the growing salience of an “anti-biologizing” explanatory framework that psychiatrists and researchers are using to pre-empt the kind of diagnostics-driven “biopsychiatrization” so prevalent in North America. My analysis suggests that psychiatrists' use of this framework ironically contributes to their failed attempts to “resist” pharmaceuticalization.

The Politics of Clinic and Critique in Southern Brazil

“…Yet their overwhelming sense of disempowerment often prompted a return to suspicious hermeneutics centred on resisting epistemic reductionism. While engendering a sense of agency, this also fed what I have described elsewhere as a recursive gridlock of biopolitical 'reproduction' and bio-epistemic 'resistance' (Béhague, 2015).…”

“…My fieldwork indicates that languages, values, and aesthetics linked to these two figures were being used and distributed in ways that brought history into a palpable and manipulable present. In the ethnographic and epidemiological studies of the Pelotas cohort, we found that young people were more likely to be framed (and to frame themselves) in behavioural terms – as agitated, inattentive, and with disordered conduct – if they were young men, reported lower family income, and if they identified as ‘black’ or of ‘mixed’ race ( Béhague, 2015 ). In contrast, a framing reminiscent of a psychoanalytic ‘storm-and-stress’ view of adolescence was more frequently used for and referenced by young women, and those who reported higher family incomes and identified as ‘white’.…”

Depression

“…In contrast, middle-class youth used antidepressants to temporarily facilitate the crucial work of refashioning a resilient internal self. These different uses served to reinforce long-standing views of the psychological inferiority of marginalised populations (Béhague 2015). These wide-ranging discourses surrounding antidepressant use demonstrate that, despite its globalisation, depression continues to be a localised 'polysemic symbol' (Barrett 1988: 375) DSM-IV, called the 'loss of sadness' (Frances 2013).…”

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

“…Prescription and use of psychotropic drugs-or their rejection-in mental health care, as Béhague (2015) has argued, do not result from a simple rational and instrumental adherence to a certain explanatory model of mental suffering (whether biopsychiatric, psychodynamic, or psychosocial). Such narratives and practices are immersed in "the broader moral, social, structural, and economic contingencies that drive (or circumvent) pharmaceuticalization" (Béhague 2015: 321).…”