A categoria da alienação na análise do sofrimento psíquico em mulheres

articulações entre a determinação social da saúde-doença e a psicologia histórico-cultural

Abstract

Introduction: Two Marxism-based theories - Latin American social determination and historical-cultural psychology - are articulated to advance the explanation of psychological suffering through the dialectic of objectivity-subjectivity and the unity of individual-society. The descriptive treatment given to disorders in psychiatric manuals aligns with the psychopharmacologization and mentalization of life (Costa, 2024). Advancing anti-asylum debates and practices implies unveiling social determinations engendered by the “knot” of class, race/ethnicity, and gender (Saffioti, 2015 [2004]). Health is the fullest development of human potential, of the human genus toward the social being, conditioned by the degree of historical-social advancement (Garcia, 1989), but also by dehumanizing processes. Psychological suffering is the product of complex mediations between the singular, particular, and universal, transcending mere somatic individuality. We use Martins’ (2007) formulations on alienation alongside the debate on frustrated needs (Breilh, 2006). It is necessary to articulate Marxist theorization in collective health (grounded in the struggle against the effects of class conditions on health) with an understanding of the human psyche from historical-cultural psychology, to reach the level of singularization in ontogenetic development without losing its universal connections when addressing such “personal” phenomena. Objective: To examine the operationality of general formulations about health needs and personality alienations, analyzing those specifically imposed on women in Brazilian capitalist social formation, in order to advance theoretical understanding and insurgent practices regarding the social determination of psychological suffering in its contemporary, gendered form, called depression. Methodological Procedures: Theoretical study derived from field research that interviewed women diagnosed with depression (empirical results are not described here but inspired and oriented this essay). A dialectical analysis of the concepts of alienation (according to Marx and contemporary authors of historical-cultural psychology) and needs (Breilh, 2006) is developed, emphasizing the implications of their daily frustration, particularly among women. Development: In the Brazilian social formation, within the escalation of the capital-labor conflict intertwined with patriarchy and racism, inequalities and obstructions proliferate - with violence as their apex - hindering the full development of higher psychological processes, such as the constitution of personality, which depends on material and symbolic bases. The dialectics of life occur in the body and personality according to one’s social insertion. The overdetermination of complex, multidimensional historical-social processes incorporates, by subsumption, others such as the biopsychic (Laurell, 1976), as can be observed in depressive symptoms like self-devaluation, resignation, loss of will, and loss of life meaning. To affirm the social determination of mental health deterioration as a violation of the potential to become a unique, conscious being realizing the universal genus is not to deny its biological bases. Depression is not an illness of neurochemical origin but expresses in the biopsychic unity the contradictions of society. It reflects the disorganization of the personality’s structure of motives, invaded by external pressures and demands (Almeida, 2018), revealing ruptures between the meaning of activity and the concrete possibilities of objectifying needs. The Marxian concept of alienation synthesizes the rupture of the ontological role of labor in the capitalist sociometabolism. Psychological expressions of alienation (Montero, 1991, apud Martins, 2007) appear as: “feeling of powerlessness” - impotence and inability to direct one’s life; “feeling of absurdity” - low expectation in the relation between actions and results; “isolation,” hopelessness, and detachment from social values; “self-estrangement” - dependence on external rewards; “absence of norms” - rupture of individual-environment bonds. Forms of alienation signal the impoverishment of values and ties, and the fetishization of people and relationships. These processes converge in the formation of an alienated personality, with a loss of coherence between thought, emotion, and action (Martins, 2007). Breilh (2006) goes beyond basic needs, incorporating those related to psyche and consciousness: identity, affective fulfillment, social participation, freedom of thought, and formative recreation. We ask: are these needs satisfied or frustrated for the majority of Brazilian women? The needs linked to the psyche give content and direction to human life and are “the most violated by societies of inequality,” eroding substantive quality of life (Breilh, 2006, p. 175). Alienation and its psychological singularizations in subalternized women make them more vulnerable to depressive illness manifested as low self-esteem, hopelessness, fatalism, and inaction. Thus, the intertwining of unsatisfied needs and personality alienations, manifested as depressive symptoms, is reaffirmed. The absence of emancipatory mediations (e.g., feminist-class-based mediations in welfare actions, care, and social policies) aggravates the risks and harms caused by capitalist domination, instead of countering them, leaving untouched the internalization of structural violence and symbolism. Abstracted from Marxist ontology, conventional epidemiology, psychiatry, and even Psychosocial Care lose their capacity to explain the radicality of the collective suffering produced and subjectively individualized. Final Considerations: This essay deepens the understanding of how alienation, particularly in its psychological expressions, can be employed as an analytical category of depression, through which most women’s suffering manifests under the weight of gendered structural subordination. Indissociable from class and race, these oppressions affect personality and health-disease-care processes. Alienation exposes the (non)realization of needs under given conditions. The theoretical frameworks presented are thus more capable of overcoming individualizing interpretations, rescuing the collective and historical character of suffering that massively expresses itself today. Rejecting the individual responsibility for mental health, we reaffirm the need to develop social policies and technologies committed to societal transformation, acting beyond the phenomenal. Greater radicality in collective and mental health is urgent. Only care practices that recognize suffering as a singular, existential expression of social alienation - and not as individual failure - can reverse the gendered and racialized interdictions of needs. These interdictions mark self-consciousness with meanings such as inferiority, dependency, passivity, devaluation, subordination, and resignation. They converge in the impoverishment of life and the acceptance of need frustrations. The social struggle for a dignified life for all is the real struggle for women’s mental health.