Madness and Social Change : Autobiography of the Brazilian Psychiatric Reform

In this book, the history of the Brazilian Psychiatric Reform is told by one of its main protagonists. In the early 1980s, there were about 80 thousand people admitted to psychiatric hospitals in Brazil, with average lengths of hospital stay of approximately 25 years. The psychiatric reform process that took place in the country was responsible for closing more than 60 thousand beds in mental asylums, most of them characterized by conditions of violence and abandonment. The Brazilian Psychiatric Reform was inspired by the psychosocial care model introduced by psychiatrist Franco Basaglia in Italy and was marked by the broad participation of social movements, such as the anti-asylum movement and other human rights movements. This process gave rise to a model of mental health care based on open-door territorial mental health services, guided by the principle of treatment in liberty, in addition to other strategies of deinstitutionalization. More than a proposal to restructure or modernize the mental health care model, the objective of the Brazilian Psychiatric Reform was the construction of a new social place for the diverse and singular subjective experience of madness. By intending to produce new imaginaries, new social representations and new meanings for these experiences, the Brazilian Psychiatric Reform led to one of the larger experiences of deinstitutionalization in the world and to the large scale implementation of a new model of mental health care in which the old asylum-centric paradigm was replaced by a new democratic psychosocial care model. Foreword to the International Edition, by Manuel Desviat Brazil (1976–2016) – Four Decades at the Forefront of Psychosocial Care for Psychic Suffering References Foreword to the Brazilian Edition Author’s Preface to the International Edition Acknowledgments Contents Chapter 1: Introduction: Dimensions of the Psychiatric Reform as a Complex Social Process 1.1 Theoretical-Conceptual or Epistemological Dimension 1.2 Technical-Assistance Dimension 1.3 Legal-Political Dimension 1.4 Sociocultural Dimension: Producing a New Social Place for Madness and Psychological Suffering References Chapter 2: The “Industry of Madness” Is Denounced: Birth of the Brazilian Psychiatric Reform 2.1 The 1980s: From Institutional Criticism to the “Institutionalization” of the Psychiatric Reform 2.2 Late 1980s: From Institutional Critique to De-institutionalizing Practices 2.2.1 Center for Psychosocial Care 2.2.2 Innovative Experience of the Santos Substitutive Network 2.2.3 The NAPS Project Within the Framework of the Santos Proposal 2.3 The End of the 1980s: The Psychiatric Reform Bill 2.3.1 The Network of Comprehensive Mental Health Care as a Substitute for Mental Institutions in São Paulo 2.4 The 1990s: Caracas Declaration and Psychiatric Reform in the Latin American Region 2.5 Expansion of the Notion and Meaning of Networks and Psychosocial Care Services 2.6 The 2000s Onward: Advances, Innovations, and Problems During Psychiatric Reform 2.6.1 A New Political Framework: RAPS 2.6.2 Mental Health in Primary Care: Radical De-institutionalization? References Chapter 3: The Sociocultural Dimension: Concrete Experiences About Production of a New Social Place for Madness and Psychological Suffering 3.1 Participation and Social Control: The National Anti-Asylum Struggle Movement and the Emergence of Abrasme 3.1.1 Abrasme: A New Social Actor Emerges in the Brazilian Psychiatric Reform Field 3.2 Health Councils and Conferences 3.2.1 National Mental Health Conferences 3.3 Sociocultural Dimension in Work, Income Generation, and the Solidarity Economy 3.4 The Sociocultural Dimension in Art-Culture 3.4.1 Psychiatric Reform Projects Are Now Incorporated into Cultural Public Policies References Chapter 4: Final Considerations and Comments: Health and Psychiatric Counter-Reform or Dismantling the Brazil’s Rule of Law 4.1 Psychiatric Reform: Protagonism and a Social Movement’s Power 4.2 New Subjects of Rights: Advances in the Legal-Political Dimension 4.3 Technical-Assistance Dimension: More Care and Citizenship, More Rights and Autonomy References