Limitações da psiquiatria biomédica Controvérsia entre psiquiatras farmacológicos e reforma psiquiátrica Psiquiatria não comercial e íntegra Suporte para desmame de drogas psiquiátricas Concepções psicossociais Gerenciamento de benefícios/riscos dos psicoativos Acessibilidade para Deficiência psicossocial Psiquiatria com senso crítico Temas em Saúde Mental Prevenção quaternária Consumo informado Decisão compartilhada Autonomia "Movimento" de ex-usuários Alta psiquiátrica Justiça epistêmica
Essa avalanche de informações e conhecimento relacionada à saúde e despejada todos os dias sobre os indivíduos sem a menor cerimônia varia muito em termos de objetividade e credibilidade. Porém, é preciso admitir que ela consegue atrair cada vez mais a atenção pública para assuntos de saúde - e muda o relacionamento tradicional entre médicos e pacientes, encorajando os últimos a exercer uma atitude mais participativa na relação.
Ironicamente, enquanto os pacientes conquistam mais acesso às informações sobre saúde, os médicos têm cada vez menos tempo para estudar as últimas descobertas científicas ou para ler publicações da área - on-line ou não -, e mesmo para se comunicar adequadamente com especialistas de áreas relevantes e/ou com os próprios pacientes.
Além disso, enquanto os médicos precisam dominar conhecimentos sobre as diferentes condições de saúde de um grande número de pacientes cujos rostos eles mal conseguem lembrar, um paciente instruído, com acesso à internet, pode, na verdade, ter lido uma pesquisa mais recente do que o médico sobre sua doença específica.
Os pacientes chegam ao consultório com paginas impressas contendo o material que pesquisaram na internet, fotocópias de artigos da Physician's Desk Reference, ou recorte de outras revistas e anuários médicos. Eles fazem perguntas e não ficam mais reverenciando a figura do médico, com seu imaculado avental branco.
Aqui as mudanças no relacionamento com os fundamentos profundos do tempo e conhecimento alteraram completamente a realidade médica.
Livro: Riqueza Revolucionária - O significado da riqueza no futuro
Aviso!
Aviso!
A maioria das drogas psiquiátricas pode causar reações de abstinência, incluindo reações emocionais e físicas com risco de vida. Portanto, não é apenas perigoso iniciar drogas psiquiátricas, também pode ser perigoso pará-las.
Retirada de drogas psiquiátricas deve ser feita cuidadosamente sob supervisão clínica experiente. [Se possível] Os métodos para retirar-se com segurança das drogas psiquiátricas são discutidos no livro do Dr. Breggin: A abstinência de drogas psiquiátricas: um guia para prescritores, terapeutas, pacientes e suas famílias.
Observação: Esse site pode aumentar bastante as chances do seu psiquiatra biológico piorar o seu prognóstico, sua família recorrer a internação psiquiátrica e serem prescritas injeções de depósito (duração maior). É mais indicado descontinuar drogas psicoativas com apoio da família e psiquiatra biológico ou pelo menos consentir a ingestão de cápsulas para não aumentar o custo do tratamento desnecessariamente.
Observação 2: Esse blogue pode alimentar esperanças de que os familiares ou psiquiatras biológicos podem mudar e começar a ouvir os pacientes e se relacionarem de igual para igual e racionalmente.
A mudança de familiares e psiquiatras biológicos é uma tarefa ingrata e provavelmente impossível.
https://breggin.com/the-reform-work-of-peter-gotzsche-md/
In this piece for Medium, Brendan O’Neill critiques campaigns that
aim to de-stigmatize “mental illness” and the trend toward identifying
as “mentally ill.”
“The problem here is that people are being
told it’s cool not to be able to cope, to embrace the identity of
fragility. They are invited to think of themselves as incapable, to
build their personality around being pathetic. That’s terrible. The
generous reading is that this ultimately expresses society’s inability
to provide people with a sense of
purpose in their lives, with a moral framework for making sense of the
world and our place within it, and this gives rise to a situation where
people come to understand the problems they face not as social,
political or economic, but as psychic. This is true, and it’s a very
worrying phenomenon. But at the same time, don’t people also have choice
and autonomy, however diminished these things might now be? Can’t they
refuse to adopt the mental-illness tag?”
"
Que a genialidade e a loucura têm um lado que fazem fronteira, sim,
confunde-se, eis aí algo frequentemente notado. Até mesmo o entusiasmo
poético foi denominado uma espécie de loucura: amabilis insania é como a
denomina Horácio. Na introdução a Oberonm, Wieland fala de uma 'doce
loucura'. Mesmo Aristóteles, segundo Sêneca, disse: 'Nunca houve grande
engenho sem uma mistura de demência' [...] O filósofo também diz[Platão]
no Fedro que sem uma certa loucura poeta algum se faz. Em verdade, todo
aquele que conheceu as Ideias eternas nas coisas efêmeras aparece como
louco. Também Cícero assevera: Demócrito afirma que sem loucura não pode
haver grande poeta; o mesmo diz Platão'. Por fim Pope diz:
' A loucura é aparentada ao grande espírito/ Ambas são separadas por um tênue muro'."
Schopenhauer, O Mundo como Vontade e como Representação
The new edition of the DSM, the so-called “Bible” of psychiatry, is out.
But many psychiatrists and psychologists say the manual’s approach is
outdated, boxing mental illness into discrete categories like
schizophrenia or bipolar disorder, when very little is known about the
underlying causes of disease.
The DSM-V, the standard
classification of mental disorders used in the United States, is
considered by many to be the bible of the psychiatry world. Its
descriptions of mental illness provide guidance to clinicians and
insurers on diagnosis and treatments. But the manual has also been
criticized over the years for its categorical approach to mental
disorders, for symptom lists that are too strict or not strict enough,
and for its many iterations and revisions. [Is the DSM’s approach outdated?] In her new book The Power of Different: The Link Between Disorder and Genius,
psychiatrist Gail Saltz adds her own critique to that list. Saltz asks
what if what the DSM—and by extension the society—considers brain
disorders are actually brain differences? “It’s arguable that what we
call mental disorder—as if it were an aberration—is in fact a natural
part of our diversity as a species,” she writes.
As a psychiatrist, Saltz understands
that not all mental disorders can be viewed in such a wholly positive
way. Every illness, from dyslexia to autism, comes with its own
challenges and painful struggles. But with those challenges come some
unique creative abilities. Citing the often stigmatized bipolar
disorder, Saltz writes: “Arguably, if you removed all of those with
bipolar disorder from the arts and creative fields, there would be
vastly less creativity in the world. We would have no Hemingway. No Anne
Sexton. No Virginia Woolf. Very possibly no Beethoven, either.” Dr. Gail Saltz joins Ira to discuss her thoughts on creativity abilities and the many categories of brain difference.
Segment Guests
Gail Saltz
Gail Saltz is the author of The Power of Different
(Flatiron Books, 2017). She’s a Clinical Associate Professor of
Psychiatry at New York Presbyterian Hospital in New York, New York.
From Psych Central: A new meta-analysis found no evidence for a
previously reported connection between the serotonin gene, depression,
and stress.
“For years, scientists have been trying to determine
what effect a gene linked to the brain chemical serotonin may have on
depression in people exposed to stress. But now, analyzing information
from more than 40,000 people who have been studied for more than a
decade, researchers led by a team at Washington University School of Medicine in St. Louis have found no evidence that the gene alters the impact stress has on depression.”
O artigo que se segue é uma tradução do artigo Ritalin Gone Wrong [1], publicado no jornal The New York
Times em 28 de janeiro de 2012. Ela foi realizada e gentilmente
concedida ao Comporte-se pelo Prof. Dr. Roosevelt Starling [2]. Escrito
por Alan Sroufe, professor emérito de Psicologia no Instituto de
Desenvolvimento Infantil da Universidade de Minnessota – USA, o texto
trata do uso de fármacos como Ritalina e Aderall para o tratamento de
problemas de atenção e concentração em crianças. Apresenta e discute
resultados de estudos em larga escala em que se verificou a efetividade
destes medicamentos e traz a opinião do pesquisador sobre o assunto.
Rorschach and his inkblots: The man, the test, the controversy
When psychiatrist Herman Rorschach used inkblots to open a window into his patients’ minds, he also opened a can of worms
Card 2 of Hermann Rorschach’s 10 inkblots. What do you see?
Science Museum/Science & Society Picture Library
By Damion Searls
NUREMBERG,
1945. Hitler, Himmler and Goebbels were dead, but two dozen other
leading Nazis were awaiting trial for crimes against humanity. The prize
catch was the creator of the Gestapo and the death camps, Hitler’s
number two: Hermann Göring.
While they waited, prison psychologist Gustave Gilbert administered
psychological tests, keen to solve the mystery of the “Nazi mind”. Most
of the prisoners responded like show-off schoolboys, eager to beat their
peers. They did well on IQ tests, but to assess their personality there
was another technique to try, and the prison psychiatrist, Douglas Kelley, had written a book on it. He and Gilbert gave 19 Nuremberg prisoners the Rorschach test.
Hermann Rorschach, a psychiatrist working alone in a remote Swiss asylum, had invented the inkblot method
in 1917 and published it in 1921. Rorschach was a follower of Freud,
though never doctrinaire or dogmatic: he once joked to a colleague, “In
Vienna, they’re going to be explaining the rotation of the Earth
psychoanalytically before long.” He had also studied with Carl Jung in
Zurich, where Jung had developed the first empirical test of the
unconscious mind: word association.
.
Rorschach was a lifelong artist. In school he was known for his
drawing skill and, aptly, his nickname was “Klex”, the German word for
inkblot. He was visual, whereas Freud was a word person. Psychoanalysis
was built around the talking cure, slips of the tongue, what we say and
don’t say, but Rorschach thought how we see was more revealing than what
we see.
After extensive revisions, Rorschach decided on 10 inkblots to make
up the test. The same 10 are still used today, 100 years on. They are
not random smears: they have structure, visual qualities beyond mere
ambiguity. For instance, they are challenging to integrate into a whole,
so that while some of us can pull together a big picture, others get
hung up on details. And do you see movement and life, or only cold,
inanimate forms? There’s one blot that almost everyone says looks like a
bat or moth; do you say likewise?
Rorschach gave scores based on the frequency of what he termed
“whole”, “detail” and “movement” responses, among others. You could
calculate ratios with those scores, and track patterns. The test results
were derived from these measures. Rorschach originally called his
inkblots a perception experiment, not a test; it simply explored how
people process visual information. Only later did he realise that
different kinds of people tend to see the blots differently.
Nazi personality
In the decades after his early death in 1922, aged 37, of
appendicitis, Rorschach’s test languished in Switzerland and Germany.
But practitioners in the US helped it surge to prominence. That’s why in
1945, Kelley and Gilbert, both Americans, saw a golden opportunity to
try it on prominent Nazis.
Ultimately, though, the Rorschach test wasn’t considered a success at Nuremberg
because it didn’t identify a “Nazi personality”. Although it found some
common elements, such as a certain lack of introspection, the Nazis
showed essentially the same range of variation, from the psychotic to
the very well adjusted, as any other group. This result was unacceptable
to both psychologists and the general public – surely only monsters
could do what the Nazis had done – and so the findings were disregarded
for decades.
Meanwhile, in the mid-century heyday of Freudian psychoanalysis, the
Rorschach test became the leading “X-ray of the unconscious”. It was
used in the most ham-fisted ways imaginable, and was expected not just
to reveal mental illness or personality, but to practically read minds.
Too many death-related responses to an inkblot dubbed the suicide card
and you became a candidate for electroshock therapy.
Had he lived, Rorschach would have been appalled that an inkblot test
could result in such drastic treatment. Shortly before his death, he
wrote to a colleague eager to use the test to evaluate academic
potential: “When I imagine some young person, who has maybe dreamed of
going to university from an early age, being prevented from doing so as a
result of failing at the experiment, I naturally feel a bit like I
can’t breathe.”
“Used in the most ham-fisted ways, the test was expected to practically read minds”
Rorschach anticipated many objections to his test, in particular the
potential conflict between its numerical results and a doctor’s
subjective insight into their patient. This “dilemma… comes up
unfortunately quite often in the test,” he noted. But Rorschach took the
side of scientific objectivity: “All my work has shown that crude
systematisation is better than arbitrary interpretation.”
Yet many psychiatrists preferred their own interpretations, and so
the Freudian incarnation of the Rorschach test captured the world’s
imagination, spreading into film noir, advertising and popular culture.
This version eventually, justifiably, met with widespread criticism. In
the late 60s, it began to fall out of favour, along with Freud. In the
UK and elsewhere, it has never recovered. But in the US, the test was
reinvented in the 1970s with a renewed emphasis on numerical results.
Hermann Rorschach, doing his best Brad Pitt
www.bridgemanimages.com
From the beginning, the test was meant to be a science, not an art. A
priority for Rorschach was that it could be scored objectively.
Although he initially logged responses as “+” or “-” for being good or
poor descriptions of the card, he collected a large data set as quickly
as he could and shifted to scoring answers as Popular or Uncommon,
independent of his own subjective judgement.
The mountains of data collected and analysed since the test was
invented allowed statistical norms to be established. After psychologist
John Exner devised a “Comprehensive System” for scoring in 1974, the
test gave a more complex readout than ever before, with all sorts of
measurable numerical thresholds. These in turn could be mapped to
diagnoses in the US psychiatrist’s handbook, the Diagnostic and Statistical Manual of Mental Disorders, or other accepted assessments.
Whether such mapping is reliable has been controversial for decades,
and is the subject of a great deal of research. Is the Rorschach test,
even in its modern incarnation, just an excuse for a psychiatrist to
draw whatever conclusions they want? According to a giant meta-analysis published in 2013 in Psychological Bulletin,
the answer is no. In the light of that study, even some of the test’s
most vocal critics agreed that its ability to detect and differentiate
between psychotic thought disorders now had scientific support. And
those of Exner’s scores that were found not to meet scientific standards
of validity and reliability were removed from the system, leaving the
rest on a firm footing.
The inkblots have been used in so many ways in the 100 years since
Rorschach sent them out into the world that they can seem as hard to pin
down as human nature itself. And, as with any tool, there is scope for
misuse. Gilbert failed to heed what the inkblots told him in Nuremberg,
and continued to believe that there was a “Nazi personality”: in 1963,
he published an article with the lurid title “The mentality of SS
murderous robots”. Yet Kelley, the more expert Rorschacher, had found
nothing particularly out of the ordinary – simply the banality of evil.
No test can get around the complexity of how different people see the
world, and that complexity will always generate controversies. One can
only wonder what Rorschach himself would have made of it all. This article appeared in print under the headline “How you see it, how you don’t”
"A
loucura é diagnosticada pelos sãos, que não se submetem a diagnóstico.
Há um limite em que a razão deixa de ser razão, e a loucura ainda é
razoável. Somos lúcidos na medida em que perdemos a riqueza da
imaginação."
Carlos Drummond de Andrade
Aos prognósticos desesperançados da psiquiatria tradicional contrapõem-se diversas iniciativas que apontam novas maneiras de assumir a práxis da Atenção Psicossocial. A abordagem de “estar em recovery” ou personal recovery, assumida como distinta de uma recuperação médica ou clínica, revela-se uma forma potente de enfrentamento da inexorabilidade intrínseca de deterioração das pessoas com transtornos mentais de alta e média gravidades. Uma das principais proposições nesta visão é que as pessoas diagnosticadas com transtornos mentais graves podem encontrar significado em suas vidas e alcançar plenos estados de recuperação (CALABRESE; CORRIGAN, 2005)
RECOVERY: O DESVELAR DA PRÁXIS E A CONSTRUÇÃO DE PROPOSTAS PARA APLICAÇÃO NO CONTEXTO DA REFORMA PSIQUIÁTRICA NO BRASIL
Recovery: Unveiling Praxis and Construction of Proposal for Implementation in the Context of Psychiatric Reform in Brazil
Walter Ferreira de Oliveira, Ph.D. 1
"Este conceito de recovery se refere primeiramente a uma pessoa diagnosticada com um transtorno mental severo, reivindicando seu direito a uma vida segura, digna, gratificante e plena de sentido, inserida na comunidade, apesar de sua condição psiquiátrica. Ele enfatiza a auto-determinação e objetivos de vida “normais”, como educação, trabalho, sexualidade, amizade, espiritualidade, e participação voluntária em comunidades de fé e de outros tipos, para além dos limites tanto do transtorno e do sistema de saúde mental, e consistente com as próprias preferências, objetivos e valores de cada pessoa. O que claramente está ausente neste conceito de recovery é qualquer noção de cura [...] Para pessoas com estas e outras formas de ‘disabilidades’, questões como acesso e moradia não são consideradas como somente questões de crescimento e desenvolvimento, ou qualidade de vida, mas são vistas mais como fundamentais para os direitos e responsabilidades da cidadania. Embora elas não restaurem a mobilidade ou visão da pessoa, eles podem e são capazes de restaurar o status de uma pessoa valorizada e que pode contribuir para a sociedade. É por essa razão que estas questões estão estruturadas como questões de direitos civis e justiça social, para além de questões apenas de saúde. O mesmo deve ser verdadeiro, de acordo com o movimento de recovery, para pessoas com ‘disabilidades’ psiquiátricas. Esta abordagem é o que está implícito na noção de estar em recuperação” (DAVIDSON, 2009: 11 e 14).
In this essay
for Aeon, David Colquhoun deconstructs the concept of statistical
significance and discusses the problematic nature of the way scientific
research is conducted.
