CLOSING A PSYCHIATRIC HOSPITAL AS AN EVENT: DEVELOPMENTS OF THE PSYCHIATRIC REFORM
Psychiatric Hospital; Mental health; RAPS;
From the beginning of the 1970s until the year 2016, in Crato, located in the south of Ceará, the psychiatric hospital Casa de Saúde Santa Teresa operated. It was opened according to the context of the time, with intense asylum investment in the country, meeting the proposal for segregation and hygienism aimed at organizing cities and circumscribing the place of subjects in psychological distress. Private institution, however financed with public resources throughout its existence, despite the advances in the anti-asylum struggle and the psychiatric reform process in Brazil, with the proposition of a new model of mental health care, started shortly after the opening period. of the Casa de Saúde, it lasted for more than 40 years. Some aspects facilitated the maintenance of the hospice and made it remain refractory to the changes that were occurring at a global and national level in relation to the large psychiatric hospital structures. First of all, we highlight the privileged geographical location, making its services meet the demands of several cities in Ceará and neighboring states such as Paraíba, Pernambuco and Piauí. Second, the opening and consolidation of substitute devices and the Psychosocial Care Network / RAPS in the region, as part of the process of changing the logic of care in mental health, did not happen quickly and without obstacles. The Casa de Saúde Santa Teresa, even though it is an obsolete model of psychiatric care, occupied a prominent place for being the support available in this scenario of building another structure of attention and care in mental health, being, therefore, the only alternative for residents of that region. Only in 2016, macro-structural conditions were created to enable the closure of the hospital unit, as well as all the reordering with regard to mental health in the Cariri region of Ceará. The hospital closed its doors and the effects of this began to be noticed, especially in Crato, Juazeiro do Norte and Barbalha, for which the Casa de Saúde served as a reference. One of these was the progressive restructuring of RAPS in the region. Currently, the mental health network has two CAPS (II and AD) in Crato, three CAPS in Juazeiro do Norte (III, AD and i) and three CAPS in Barbalha (III, AD and i). This scenario has not changed so far, as a result of the dismantling strategies operated since the 2016 politic break that aimed to strengthen the hospital's psychiatric apparatus. In this logic, the Therapeutic Communities proliferated, currently adding up to a total of 19 establishments in the region. In this context of advances and setbacks, the closure of the Casa de Saúde Santa Teresa is taken as an event, thought from the Deleuzian perspective. According to the philosopher, “the event is the meaning itself. The event essentially belongs to language, it maintains an essential relationship with language; but language is what is said about things” (Deleuze, 2000, p.34). There is, above all, an aporetic constitution for this event, since the closed space remains in the imaginary and needs to be effectively replaced by other practices of care production. The hospital closes, but the rooted asylum logic still persists, the number of Therapeutic Communities grows. Taking the closure of the hospice as an event allows one to think about it without a priori evaluative attributes. What seems or can be considered good, according to a conjunctural analysis, is projected as an unknown, a deviation whose ignored course is built by the multiplicity given in time. The closure of the asylum unit in the interior of Ceará is a product and producer of speeches about the madness and updating of its characters. In the language order, the event narrates and signals a rupture, certainly producing effects still unknown that do not occur in a direct causal relationship with the closure of the Casa de Saúde Santa Teresa alone, but in relation to all the ethical, political and anthropological developments of a time to come. If the psychiatric hospital had the classic figure of the madman, from the event, a deviation produced by its closure: what new spaces are opening up? What remains of asylum macrostructures? Who are the men and women who inhabit these spaces and this inheritance of the stiffened asylum logic? This work aims to follow the developments that take place after the closure of an asylum, crossed by the advance of fascist policies, neoliberalism politics and the economic and health crisis as a result of the COVID-19 pandemic that ravaged the world from 2020 Our research of accompanying the installation of new services and forms of care production, as well as the analysis of the political and affective effects produced in the territory, as a result of investment and struggle by the reformist movements, also included the idea of accompanying their antagonists, that is, the present possibility of retrogression and dismantling of the anti-asylum politics advances, meeting the imperatives of neoliberal and capitalist government and contingencies of time. Certainly, this process of reordering is inscribed in the daily life of cities, in people and in the ways of life. The methodology for conducting this research is of a cartographic nature and aims to monitor the flows and developments of this event. As methodological strategies, we use field diaries, visits to mental health services, quantitative data made available by the state and municipal health departments and those collected from official sources. In addition, we’ll use too photographic records and images made during visits to the old asylum and the devices that replace it. Since it is not intended to analyze discourses made by a specific group, but to think about the event and its developments in a broad context related to the Psychiatric Reform policy in the country, the cartographic path will be critical, in the light of the theoretical productions in the area. The expected result is the problematization of the direction of Psychiatric Reform in the country, in relation to the variables of the field, in a macro and micropolitical perspective, which articulates the description and identification of the clashes and impacts produced in the territory, in the political-assistance field, in the modes of subjectification, in the madness-city relationship, in the inclusion / exclusion policies updated from the event and ordering of cities in relation to the phenomenon of madness.