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.
Highlights
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
Resistance to the biomedicalization of psychiatry has been partially shaped by Brazil’s recent deinstitutionalization and community-based psychiatry movements, which began flourishing with the health system reforms that were initiated in 1984 as part of wide-ranging postdictatorship governmental and political changes
After two years of intermittent support from a psi therapist during times of increased social conflict, Flavio went so far as to become active in his school’s club for student representation, an entity considered foreign and elitist by most lower-class youth. These results suggest the evolution of a more complex, cyclical, relationship between political consciousness-raising, medicalization, emotional distress, and political action
Summary
Medical anthropologists have developed considerable insight into the question of how modern medicine garners power and authority. Ethnographers who conducted their research during this era are understandably attracted to psychodynamic psychiatry and to the idea that biomedical psychiatric institutions, in most historical and social settings, are hegemonic, biologically reductionistic, and characterized by a tendency to blame and stigmatize individuals (Young 2008). Underlying this attraction is a particular reading of Foucault’s works that, as Ian Hacking has argued, has ceased being productive and tends to reify futile debates about the “socially constructed” nature of illness (Hacking 1998, 1999). This dynamism means that some psychiatric practices are becoming politically and socially sensitized in ways that can be attributed to the legacy of the antipsychiatry movement, but that are probably quite distinct from the trappings that led to the movement’s earlier failures in some countries (Behague 2008)
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