Querer ficar, querer sair: os paradoxos da internação psiquiátrica para usuários de serviços de Saúde Mental

Abstract

The Reform of Psychiatric services in Brazil is in process of consolidation and the transition from treatment at psychiatric hospitals to rehabilitation and shelter services is still under way. As such, due to a variety of reasons, some clients of these services prefer to remain at psychiatric hospitals instead of returning to their homes. Research was carried out at a psychiatric hospital attached to SUS (Sistema Único de Saúde) and located in the city of São Paulo, in order to better understand the reasons for the resistance to disinterment. Information was gathered with clients and professionals using a diversity of research strategies (observations, conversations, interviews and participation in routine activities) during the visits made to the institution between August 2005 and March 2006. Interviews were carried out with patients that, according to the various health professionals working at this institution, externalized the "desire to remain in the internment" and with a Charity Sister that assumed the role of "spokesman" for the professional team. The analysis was base on Discursive Social Psychology in dialogue with a constructionist perspective. The desire to remain at the hospital was based on multiple factors, including lack of financial conditions, of housing, family, work and social relationships, as well as the progressive weakening of these social bonds due to frequent psychiatric internments. Moreover, the psychiatric hospital seems to function as a protective shell from a society that is intolerant with regards to mental illness. However, the desire to remain in hospital seems to be more related to lack of alternatives than to internment itself as the people that were interviewed often were sad and their speech presented many lapses and contradictions indicating paradoxical positions regarding staying in and leaving. We conclude that it is urgent to implement the proposals of the Psychiatric Reform, specially concerning strategies for strengthening social bonds in order that the desire to return to social life can truly blossom