Search

This article aims to examine the official health examination function in the Subsistema Integrado de Atenção à Saúde do Servidor Público Federal (SIASS) from the point of view of its practitioners, namely the persons who are directly or indirectly involved in the activity of examining workers who are eligible for removal from their job functions as well as workers who need work legal framing (licenses, workload reduction, among others). For such purpose qualitative methodology was used through the analysis of 32 semi-structured and in-depth interviews, carried out in 2019, with a multi-professional team (doctors, dentists, psychologists, social workers and one physiotherapist) at 5 federal educational institutions in the State of Rio de Janeiro. The information gathered has been analyzed by means of a qualitative data analysis software, Atlas.ti, so as to organize and categorize the analytical units obtained in the interviews. Among the results, we highlight: 1) examination health functions; 2) suspicion as a principle; and 3) dilemmas with regards to the examination health work. At the end, ‘disability retirement’, a category regarding another thematic axe, was also analyzed., O presente artigo visa examinar a função da perícia oficial em saúde no âmbito do Subsistema Integrado de Atenção à Saúde do Servidor Público Federal (SIASS) a partir da visão de seus praticantes, ou seja, dos que estão envolvidos direta ou indiretamente na atividade de periciar trabalhadores que apresentam algum tipo de incapacidade para o trabalho assim como necessitam de enquadramento em dispositivos legais no trabalho (afastamentos, redução de carga horária, entre outros). Para isso, utilizou-se metodologia qualitativa por meio de análise de 32 entrevistas semi-estruturadas e em profundidade, realizadas ao longo de 2019, com equipe multiprofissional (médicos, odontólogos, psicólogos, assistentes sociais e fisioterapeuta de 5 instituições federais de ensino do Estado do Rio de Janeiro). A análise do material utilizou o software de análise qualitativa Atlas.ti para organização e categorização das unidades analíticas encontradas nas entrevistas. Dentre os achados, destacamos: 1) funções da perícia; 2) a suspeita como princípio; e 3) dilemas em relação ao trabalho pericial. Ao final, analisamos também a categoria relacionada à aposentadoria por invalidez, referente a outro eixo temático.

This is the third interview in the journal’s new “Conversations” section. Drawn from my broader project Interviews with Researchers from the Anthropology, History, and Sociology of Pharmaceuticals: Mapping Out the Area, the following discussion features Professor Toine Pieters. From his early years of lab work in the Netherlands, to his move into social sciences and history, Pieters followed a path that stretched from studying molecules to analyzing their historicization. In the course of our discussion, he adopted a didactic approach, while not losing any analytical profundity, and he addressed several topics that will certainly interest drugs studies scholars. The conversation covers such subjects as the forgotten pasts of certain pharmaceuticals; the social appeal and promises embedded in “wonder drugs”; the agency of therapeutic drugs; the co-construction of drugs, diseases, and their handlers; the social interaction between doctors and patients; and the role of promise, hope, faith, and fashion in medicine and, particularly, in pharmaceuticals.

Objective: Adolescent depression is a heterogeneous disorder, with a wide variety of symptoms and inconsistent treatment response, and is not completely understood. A dysregulated stress system is a consistent finding, however, and exhaustion is a consistent trait in adolescent patients. The aim of this paper is to critically assess current hypotheses in adolescent depression research and reframe causes and treatment approaches. Methods: A mixed-method approach involved a review based on publications from PubMed, Embase and PsycInfo, and two exemplary adolescent cases. Results: Both cases show a spiral of stress and exhaustion, but with a different profile of symptoms and coping mechanisms. Reframing both cases from the perspective of coping behavior, searching for the sources of experienced stress and exhaustion, showed coping similarities. This proved essential in the successful personalized treatment and recovery process. In combination with recent evidence, both cases support the functional reframing of depression as the outcome of a stress- and exhaustion-related spiralling mechanism. Conclusions: We propose to open up a symptom-based, mood-centered view to a model in which adolescent depression is framed as a consecutive failure of stress coping mechanisms and chronic exhaustion. Addressing exhaustion and coping primarily as a treatment strategy in adolescents and young adults might work in synergy with existing treatments and improve overall outcomes. This perspective warrants further investigation.

O artigo apresenta um debate sobre a natureza do objeto da psiquiatria. Apresentam-se duas perspectivas de abordagem da questão — o realismo e o pragmatismo. Segundo o realismo, as condições denominadas transtornos mentais existiriam de forma autônoma, a despeito da conceitualização humana. Já as perspectivas pragmáticas pressuporiam que transtornos mentais não são suficientemente explicados como tipos naturais, porque normas e interesses humanos sempre estariam presentes em classificações psiquiátricas. São descritas as características, diferenças e pontos de limitação dessas abordagens. This paper presents a debate on the nature of the object of Psychiatry. Two approaches to the issue are discussed: realism and pragmatism. According to realism, would exist autonomously the conditions known as mental disorders regardless of human conceptualization. Pragmatist perspectives assume that mental disorders are not sufficiently explained as natural types, since human norms and interests are always at stake in the making of psychiatric classifications. The specific features, differences, and limitations of both approaches are described. Les auteurs présentent une réflexion critique à propos de la nature de l’objet de la psychiatrie. D’emblée, ils postulent deux voies [approches] majeures permettant d’explorer cette question fondamentale: le réalisme et le pragmatisme. Selon le réalisme, les troubles mentaux existent comme des entites autonomes, de facon independant d’une structuration conceptuelle. D’autre part, l’approche pragmatique met en avant les enjeux sociaux ce qui permet d’en déduire et d’affirmer que les troubles mentaux ne sont pas réductible à de types naturels. Enfin, les auteurs examinent brièvement et mettent en évidence les caractéristiques et limites de ces différentes approches dans la clinique psychiatrique. El artículo presenta un debate sobre la naturaleza del objeto de la psiquiatría. Son discutidas dos perspectivas del problema: realismo y pragmatismo. Para el realismo, los trastornos mentales existen autónomamente, a pesar de la conceptua-lización humana. Las perspectivas pragmáticas suponen que los trastornos mentales no pueden ser explicados suficientemente como tipos naturales, pues las clasificaciones psiquiátricas son siempre atravesadas por normas e intereses humanos. Son descritas las características, diferencias y límites de ambos enfoques. In diesem Artikel präsentieren wir eine Debatte über die Natur des Objektes in der Psychiatrie. Wir bieten somit zwei perspektiven bezüglich dieser Problematik- den Realismus einerseits, und den Pragmatismus als gegen Stellung. Für den Realismus würden die sogenannten Bedingungen der Psychiatrischen Störungen auf autonomer Weise vorhanden sein, und dies trotz menschlicher Konstruktionen. Pragmatische Perspektiven setzten voraus das Psychische Störungen nicht genügend durch ‘natural kinds’ erklärt werden können, weil menschliche Normen und sonstige Interessen sonst immer in Psychiatrischen Klassifikationen zu finden sind. Die Charakteristiken, Unterschiede und Einschränkungen werden dieser Perspektiven werden hier beschrieben. 本文主旨是讨论精神病的本质究竟是为何物。他们提出两种可以供研究的典范：现实主义和实用主义。从现实主义的典范来说，精神病即是一种内源性，自发性疾病，不管人们对其进行什么样的概念化的总结。而实用主义典范认为由于人类的利益与各项标准始终参杂于精神病的诊断和分类过程之中，因此，他们觉得精神问题具有后天性，不全部属于内源性疾病。本文作者就此两种典范的特征、差异以及局限性做出了详细阐释。

Desde un análisis crítico de los estudios de la medicalización, y como un aporte a estas perspectivas, describimos y analizamos los modos en que la industria farmacéutica transnacional penetra en diversos espacios sociales, con diferentes estrategias de marketing, interviniendo en la consolidación de procesos medicalizadores en Argentina y Brasil. Se analizan dos modalidades de expansión de los procesos de medicalización, y se desarrollan aspectos y tendencias específicas del diagnóstico y tratamiento del TDAH en ambos países: la incidencia de la industria farmacéutica en los grupos de apoyo en Brasil y las estrategias de marketing farmacéutico orientadas a actores no médicos en Argentina. Estas dos modalidades se caracterizan por no involucrar sólo al profesional médico. La metodología incluye datos de investigaciones conducidas en Argentina y Brasil entre 1998 y 2014, con sede en la Universidad de Buenos Aires y la Universidade Estadual do Rio de Janeiro, orientadas al estudio de los procesos de diagnóstico y tratamiento del TDAH y el consumo de metilfenidato en ambos países. Se emplearon técnicas de entrevista semiestructurada individual y grupal a profesores y profesionales de salud, estadísticas oficiales y de organizaciones profesionales, y revisión de bibliografía general y especializada nacional e internacional. Concluimos que los fenómenos documentados en Argentina y Brasil ponen de relieve la importancia de efectuar investigaciones que contemplen aspectos singulares de los casos empíricos, y sus múltiples vinculaciones con entramados más amplios y en tensión de saberes, dispositivos, normativas y actores involucrados en la medicalización en el siglo XXI. From a critical analysis of medicalization studies, and as a contribution to these perspectives, we describe and analyze the ways in which the transnational pharmaceutical industry penetrates diverse social spaces, with different marketing strategies, to consolidate medicalized processes in Argentina and Brazil. We analyzed two expansion methods of medicalization processes and specific ADHD diagnostic and treatment aspects and trends were developed in both countries: the impact of the pharmaceutical industry on advocacy groups in Brazil and pharmaceutical marketing strategies aimed at non-medical actors in Argentina. These two methods are characterized by involving other actors than medical professionals. The methodology includes data from research conducted in Argentina and Brazil between 1998 and 2014, based in the University of Buenos Aires and in the State University of Rio de Janeiro, focused on the study of ADHD diagnostic and treatment processes and methylphenidate consumption in both countries. We used individual and group semi-structured interview techniques with professors and health professionals, official and professional organization statistics, and national and international general and specialized literature. We concluded that the phenomena documented in Argentina and Brazil highlight the importance of conducting investigations that covers specific aspects of empirical cases and their multiple connections with broader and intense knowledges networks, dispositives, normatives and actors involved in the medicalization in the 21st century.