A medicalização da vida social na periferia do capitalismo

Abstract

Abstract

This proposal is the result of a doctoral thesis, which aimed to analyze the relationship between the super-exploitation of the workforce and the increase in medicalization among working-class segments accessing public primary health care (PHC) services in the municipality of Florianópolis/SC. The medicalization of social life is a complex phenomenon, an open debate claimed by diverse positions reflecting different ways of conceiving reality. The topic has gained significant academic and social notoriety. It is not difficult to find news in the mainstream media highlighting Brazil as one of the largest consumers of psychotropic drugs and analyzing the generalization of mental illness in Brazilian society. The medicalization of social life starts with the incorporation into the medical field of problems that, until then, were not considered amenable to intervention. New diagnoses and new disorders emerge every day, leading us to group such diverse and heterogeneous phenomena into the same classificatory space. In this sense, the evolution of psychiatric nosology has generated a systematic branching and flexibilization of diagnostic criteria, which establish subtle forms of suffering as pathological. The strengthening of biomedical explanations for behaviors defined a normal and abnormal, medicais diagnoses, especially psychiatric ones, have become an important device in explaining and intervening in the life processes of workers in Brazilian capitalist society. This is because hegemonic explanations of expressions involving the mental health of the population tend to be approached as an "issue in itself," referring to them as an individual problem, the problem being within the individuals' heads, through chemical imbalances in their minds, as a result of personality deviations, or else as a set of moral-behavioral problems. Considering this perspective, minds or brains would be autonomous, ready-made entities that objectify themselves in individuals, producing them, in a cerebral/psychological determinism or structuralism. The field research was developed in the two largest Health Centers of the southern and mainland health districts of the capital of Santa Catarina, with users who have been diagnosed with anxiety and depression and who were waiting for care from the Social Service professionals of the respective units. Eligibility criteria considered adult users, of both sexes, receiving care from Social Service professionals at selected Health Centers, who stated they had a diagnosis of so-called Common Mental Disorders (CMD). The methodological approach was based on critical and valid qualitative research, of an observational nature, with convenience sampling due to ease of access to service users and because it is an essentially qualitative research, in which the analysis of the content of the individual's discourse was central (Bardin, 1977). For ethical reasons, the research was based exclusively on the participants' reports, without obtaining other secondary sources of information, such as access to Electronic Patient Records (EPR). Given that the medicalization of social life does not occur in isolation from macro-societal processes and determinations, and considering that the super-exploitation of labor constitutes the central core of the reproduction of dependent capitalism in Latin America—that is, it delimits the fundamental form of surplus-value production in these latitudes, being determinant for the extreme character of capitalist contradictions in these societies—in the terms of Marini (2005). The capitalist mode of production in Latin America has a “sui generis” character; this idea deals with the consideration of the particular forms that govern the reproduction of capital in dependent economies, within the framework of the development of capitalism as a world system. In this sense, the exploitation of labor presents itself in the particular form of super-exploitation and is operated through three main mechanisms. The first concerns the increase in the intensity of labor, through which the worker comes to produce, in the same workday, a quantity of goods greater than that produced under previous conditions. The second [method] would be the extension of the workday, adding surplus working time in relation to the necessary working time—that is, expanding the production period dedicated to achieving value not appropriated by the worker. The third [method] deals with the appropriation of part of the worker's consumption fund, reducing the fund necessary for the worker to guarantee their subsistence, in favor of expanding the capital accumulation fund. This is a set of modalities that promote the premature exhaustion of the physical and mental strength of workers, as well as the low remuneration for their social reproduction. Thus, this study sought to problematize the structuring and structural elements that constitute and permeate the organization and development of peripheral capitalism, without neglecting its intertwining with expressions of racism, patriarchy, and their consequences for the mental health of workers, especially in the current phase of dismantling social rights, arduously won, only partially and contradictorily materialized. It can be concluded that the medicalization of social life can constitute a widely used strategy/resource in mental health policy, with psychotropic drugs being promoted as a naturalized solution. Furthermore, it can demonstrate a way of obscuring the major issues and dilemmas experienced daily by workers as an oppressed and super-exploited class under capital.